A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle

2020 ◽  
Vol 48 (7) ◽  
pp. 1608-1615 ◽  
Author(s):  
Kade S. McQuivey ◽  
Erwin Secretov ◽  
Benjamin G. Domb ◽  
Bruce A. Levy ◽  
Aaron J. Krych ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Neck Shaft Angle ◽  
Edge Angle ◽  
Secondary Operation ◽  
Radiographic Parameters ◽  
Center Edge ◽  
Operation Group ◽  
Center Edge Angle

Background: Hip arthroscopy has been previously demonstrated to be an effective treatment for adult mild hip dysplasia. There are many radiographic parameters used to classify hip dysplasia, but to date few studies have demonstrated which parameters are of most importance for predicting surgical outcomes. Purpose: To identify preoperative radiographic parameters that are associated with poor outcomes in the arthroscopic treatment of adult mild hip dysplasia. Study Design: Case-control study; Level of evidence, 3. Methods: Radiographic analysis was performed in patients with mild hip dysplasia who underwent arthroscopic surgery between 2009 and 2015. Preoperative radiographic measurements included lateral center edge angle, Tönnis angle, neck shaft angle, anterior center edge angle, alpha angle, femoral head extrusion index, and acetabular depth-to-width ratio. Failure was defined as failure to achieve the minimal clinically important difference (MCID) utilizing the modified Harris Hip Score or as the need for secondary operation. The equal variance t test was used to analyze radiographic parameters. Statistical significance was determined using a P value of .05. Results: A total of 373 hips underwent analysis with an average follow-up of 41 months (range, 24-102 months). Of these, 46 hips (12%) required secondary operation, and 95 (25%) failed to meet the MCID. The overall failure rate was 32.4%. There was no single measurement or combination thereof associated with failure to reach the MCID. Higher preoperative Tönnis angles were associated with secondary operation, with a mean of 6.7° (95% CI, 5.3°-8.1°) in the secondary operation group versus 4.8° (95% CI, 4.4°-5.3°) in the nonsecondary operation group ( P = .006). The odds ratio was 1.12 (95% CI, 1.0-1.2; P = .05) per degree increase in Tönnis angle for secondary operation. In patients with a Tönnis angle >10°, 84% required secondary operation. Conclusion: Higher Tönnis angles portend a higher risk for revision surgery. The probability of secondary operation was increased by a magnitude of 1.12 with each degree increase in the Tönnis angle. In patients with a Tönnis angle >10°, 84% required a secondary operation.

Radiographic Indices Are Not Predictive of Clinical Outcomes Among 1735 Patients Indicated for Hip Arthroscopic Surgery: A Machine Learning Analysis

2020 ◽  
Vol 48 (12) ◽  
pp. 2910-2918 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Jaret M. Karnuta ◽  
Heather S. Haeberle ◽  
Spencer W. Sullivan ◽  
Danyal H. Nawabi ◽  
...  
Keyword(s):  
Machine Learning ◽  
Arthroscopic Surgery ◽  
Alpha Angle ◽  
Harris Hip Score ◽  
Edge Angle ◽  
Hip Impingement ◽  
Femoral Version ◽  
Center Edge ◽  
Center Edge Angle

Background: The relationship between the preoperative radiographic indices for femoroacetabular impingement syndrome (FAIS) and postoperative patient-reported outcome measure (PROM) scores continues to be under investigation, with inconsistent findings reported. Purpose: To apply a machine learning model to determine which preoperative radiographic indices, if any, among patients indicated for the arthroscopic correction of FAIS predict whether a patient will achieve the minimal clinically important difference (MCID) for 1- and 2-year PROM scores. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1735 consecutive patients undergoing primary hip arthroscopic surgery for FAIS were included from an institutional hip preservation registry. Patients underwent preoperative computed tomography of the hip, from which the following radiographic indices were calculated by a musculoskeletal radiologist: alpha angle, beta angle, sagittal center-edge angle, coronal center-edge angle, neck shaft angle, acetabular version angle, and femoral version angle. PROM scores were collected preoperatively, at 1 year postoperatively, and at 2 years postoperatively for the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL) and –Sport Specific (HOS-SS), and the International Hip Outcome Tool (iHOT-33). Random forest models were created for each PROM at 1 and 2 years’ follow-up, with each PROM’s MCID used to establish clinical meaningfulness. Data inputted into the models included ethnicity, laterality, sex, age, body mass index, and radiographic indices. Comprehensive and separate models were built specifically to assess the association of the alpha angle, femoral version angle, coronal center-edge angle, McKibbin index, and hip impingement index with respect to each PROM. Results: As evidenced by poor area under the curves and P values >.05 for each model created, no combination of radiographic indices or isolated index (alpha angle, coronal center-edge angle, femoral version angle, McKibbin index, hip impingement index) was a significant predictor of a clinically meaningful improvement in scores on the mHHS, HOS-ADL, HOS-SS, or iHOT-33. The mean difference between 1- and 2-year PROM scores compared with preoperative values exceeded the respective MCIDs for the cohort. Conclusion: In patients appropriately indicated for FAIS corrective surgery, clinical improvements can be achieved, regardless of preoperative radiographic indices, such as the femoral version angle, coronal center-edge angle, and alpha angle. No specific radiographic parameter or combination of indices was found to be predictive of reaching the MCID for any of the 4 studied hip-specific PROMs at either 1 or 2 years’ follow-up.

scholarly journals Mild or Borderline Hip Dysplasia: Are We Characterizing Hips With a Lateral Center-Edge Angle Between 18° and 25° Appropriately?

2018 ◽  
Vol 47 (1) ◽  
pp. 112-122 ◽  
Author(s):  
Michael P. McClincy ◽  
James D. Wylie ◽  
Yi-Meng Yen ◽  
Eduardo N. Novais
Keyword(s):  
Arthroscopic Surgery ◽  
Female Patients ◽  
Edge Angle ◽  
Radiographic Parameters ◽  
Center Edge ◽  
Hip Morphology ◽  
Acetabular Deficiency ◽  
Fear Index ◽  
Cam Morphology ◽  
Center Edge Angle

Background: Controversy surrounds the classification and treatment of hips with a lateral center-edge angle (LCEA) between 18° and 25°. It remains undetermined as to whether periacetabular osteotomy (PAO) or arthroscopic surgery is best used to treat this patient population. Hypothesis: Patients with hip pain and mild or borderline acetabular dysplasia defined by an LCEA between 18° and 25° have different features of acetabular and femoral morphology, as determined by other relevant radiographic measures assessing the anterior and posterior acetabular walls, anterior coverage of the femoral head by the acetabulum, and femoral head and neck junction sphericity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review of patients who had an LCEA between 18° and 25° undergoing hip preservation between January 2010 and December 2015 with either PAO or hip arthroscopic surgery was performed. Anteroposterior, Dunn lateral, and false profile radiographs were used to measure the LCEA, Tönnis angle, anterior center-edge angle (ACEA), anterior wall index (AWI) and posterior wall index (PWI), femoral epiphyseal acetabular roof (FEAR) index and posterior to anterior wall index, and alpha angle and femoral neck-shaft angle. An agglomerative hierarchical clustering analysis was then performed on the continuous radiographic variables to identify different subtypes of hip pathomorphology among the study cohort. There were sex-specific trends in hip morphology. Therefore, we proceeded to perform separate cluster analyses for each sex. Multivariate logistic regression was used to identify radiographic parameters for distinguishing between female patients who underwent hip arthroscopic surgery versus PAO. Results: Ninety-eight patients with hip pain and an LCEA between 18° and 25° underwent surgery in the study period, 77 (78%) were female, and 81 (82%) had complete radiographs for cluster analyses. The mean age was 22.6 years. Hip arthroscopic surgery was performed in 40 (41%) patients, and PAO was performed in 58 (59%) patients. The ACEA (45%), FEAR index (34%), and AWI (30%) were the most commonly abnormal radiographic parameters among all patients. In female patients, the ACEA (55%), FEAR index (42%), and AWI (34%) were the most commonly abnormal radiographic parameters. In male patients, the PWI (48%) was the most common radiographic abnormality. For female patients, 3 clusters representing different patterns of hip morphology were identified: acetabular deficiency with cam morphology, lateral acetabular deficiency, and anterolateral acetabular deficiency. For male patients, 3 clusters were also identified: posterolateral acetabular deficiency with global cam morphology, posterolateral acetabular deficiency with focal cam morphology, and lateral acetabular deficiency without cam morphology. The ACEA (odds ratio [OR], 47.7 [95% CI, 9.6-237.6]; P < .001) and AWI (OR, 3.9 [95% CI, 1.0-15.0]; P = .049) were identified as independent factors predicting which procedure was performed in female patients. Conclusion: A comprehensive evaluation of radiographic parameters in patients with an LCEA between 18° and 25° identified sex-specific trends in hip morphology and showed a large proportion of dysplastic features among these patients. An isolated assessment of the LCEA is an oversimplistic approach that may jeopardize appropriate classification and may provide insufficient data to guide the treatment of hips with additional features of dysplasia and instability.

scholarly journals Is Hip Arthroscopy Effective in Patients With Combined Excessive Femoral Anteversion and Borderline Dysplasia? A Match-Controlled Study

2018 ◽  
Vol 47 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Edwin O. Chaharbakhshi ◽  
David E. Hartigan ◽  
Itay Perets ◽  
Benjamin G. Domb
Keyword(s):  
Hip Arthroscopy ◽  
Femoral Anteversion ◽  
Harris Hip Score ◽  
Control Group ◽  
Edge Angle ◽  
Center Edge ◽  
Modified Harris Hip Score ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Appropriate patient selection is critical when hip arthroscopy is considered in the setting of borderline dysplasia (BD). It is presumable that excessive femoral anteversion (EFA) and BD may contraindicate arthroscopy. Hypothesis: Patients with combined EFA and BD (EFABD) demonstrate significantly inferior short-term outcomes after arthroscopic labral preservation and capsular closure when compared with a similar control group with normal lateral coverage and femoral anteversion. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on patients undergoing hip arthroscopy between April 2010 and November 2014. The EFABD group’s inclusion criteria were BD (lateral center-edge angle, 18°-25°), labral tear, capsular closure, and femoral version ≥20°, as well as preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale. Exclusion criteria were workers’ compensation, preoperative Tönnis grade >1, microfracture, abductor pathology, or previous ipsilateral hip surgery or conditions. Patients in the EFABD group were matched 1:2 to a similar control group with normal coverage and femoral anteversion by age at surgery ± 6 years, sex, body mass index ± 5, acetabular Outerbridge grade (0, 1 vs 2, 3, 4), and iliopsoas fractional lengthening. Results: Sixteen EFABD cases were eligible for inclusion, and 100% follow-up was obtained at ≥2 years postoperatively. Twelve EFABD cases were matched to 24 control cases. Mean femoral version was 22.4° in the EFABD group and 10.2° in the control group ( P = .01). Mean lateral center-edge angle was 22.1° in the EFABD group and 31.5° in the control group ( P < .0001). Acetabuloplasty was performed significantly more frequently in the control group ( P = .0006). No other significant differences were found regarding demographics, findings, procedures, or preoperative scores. At latest follow-up, the EFABD group demonstrated significantly lower mean modified Harris Hip Score (76.1 vs 85.9; P = .005), Nonarthritic Hip Score (74.8 vs 88.5; P < .0001), Hip Outcome Score–Sports Specific Subscale (58.3 vs 78.4; P = .02), and patient satisfaction (7.1 vs 8.3; P = .005). There were 4 secondary surgical procedures (33.3%) in the EFABD group and 1 (4.2%) in the control group ( P = .03). One patient in each group required arthroplasty. Conclusion: Patients treated with arthroscopic labral preservation and capsular closure in the setting of EFABD demonstrated significant improvements from presurgery to latest follow-up. However, their results are significantly inferior when compared with a matched-controlled group. Consideration of periacetabular osteotomy or femoral osteotomy may be warranted in the setting of EFABD to achieve optimal benefit.

scholarly journals One stage hip arthroscopy and periacetabular osteotomy: surgical technique and initial results

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Gerardo Zanotti ◽  
Fernando Comba ◽  
Eduardo Genovesi ◽  
Martin Buttaro ◽  
Francisco Piccaluga
Keyword(s):  
Surgical Technique ◽  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Combined Treatment ◽  
Radiographic Examination ◽  
Edge Angle ◽  
One Stage ◽  
Center Edge ◽  
Center Edge Angle

Aim: We purposed to describe the surgical technique and preliminary outcomes of combined arthroscopic and periacetabular osteotomy (PAO) for the treatment of non-arthritic hip dysplasia. Methods: Between May and August 2015, 4 patients (3 female, 1 male) with an average age of 29 years old (range; 22-33) had undergone one-stage hip arthroscopy and periacetabular osteotomy. Primary symptom was pain associated with instability. Upon radiographic examination, mean lateral center-edge angle of Wiberg was 12° (range; 7°-18°). Intra-articular findings were computed and primary outomes were as follows: radiographic angular correction; time to healing after pelvis osteotomy and functional results according to Merle D’Aubigné Score. Results: Minimum follow-up was 6 months whereas maximum was 9 months. Mean surgical time was 98 minutes for hip arthroscopy and 132 minutes for the osteotomy. In all cases, a lesion of the antero-superior labrum and the chondro-labral junction was found and repaired. After correction, overall postoperative center-edge angle was 29° (range; 25°-35°). Bone healing was certified in all cases at 6 months postoperatively. Overall Merle D’Aubigné Score was 17/18 points. Conclusion: Combined treatment of non-arthritic hip dysplasia with hip arthroscopy and PAO obtained good clinical and radiological outcomes. Former arthroscopy enables the diagnosis of cartilage lesions and intra-articular pathology as well as it aids in proceeding or not to an open correction.

scholarly journals Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712092085
Author(s):  
Alexander Zimmerer ◽  
Marco M. Schneider ◽  
Rainer Nietschke ◽  
Wolfgang Miehlke ◽  
Christian Sobau
Keyword(s):  
Clinical Outcomes ◽  
Hip Dysplasia ◽  
Arthroscopic Surgery ◽  
Alpha Angle ◽  
Neck Shaft Angle ◽  
Center Edge ◽  
Femoroacetabular Impingement Syndrome ◽  
Fear Index ◽  
Cluster 2

Background: Recent studies have shown that assessment of the lateral center-edge angle (LCEA) between 18° and 25° is not sufficient to adequately classify mildly dysplastic hips and that further radiological features should be considered. However, no correlation between different morphologic features and clinical outcomes has been investigated so far. Purpose: To analyze the clinical outcomes of patients with different subtypes of borderline dysplastic hips who underwent arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We examined patients with an LCEA between 18° and 25° who underwent arthroscopic treatment for femoroacetabular impingement syndrome between January 2015 and December 2016. A hierarchical cluster analysis was performed to identify hip morphologic subtypes according to radiographic parameters, including the LCEA, femoro-epiphyseal acetabular roof (FEAR) index, anterior and posterior wall indices (AWI and PWI), Tönnis angle, alpha angle, and femoral neck-shaft angle. In addition, the International Hip Outcome Tool 12 (iHOT-12) and a visual analog scale (VAS) for pain were applied preoperatively and at follow-up, and the results were compared among the different clusters. Previously reported minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values were used to determine clinically significant improvements. Results: A total of 40 patients were identified. Of these, 36 patients were available for evaluation at a mean follow-up of 43.8 months. In total, 4 sex-independent clusters with different morphologic patterns of the hip were identified: cluster 1, unstable anterolateral deficiency (FEAR index >2°, AWI <0.35); cluster 2, stable anterolateral deficiency (FEAR index <2°, AWI <0.35); cluster 3, stable lateral deficiency (FEAR index >2°, normal AWI and PWI); and cluster 4, stable posterolateral deficiency (FEAR index <2°, PWI <0.85). At follow-up, clusters 1, 2, and 3 showed significantly improved iHOT-12 ( P < .0001) and VAS pain ( P < .0001) scores, and cluster 4 showed no significant improvements. The MCID of 15.2 points was achieved by all patients in clusters 2 and 3, by 63% of patients in cluster 1, and by 23% of patients in cluster 4. Clusters 2 and 3 differed significantly from clusters 1 and 4 ( P = .02). A postoperative PASS score of 60 was achieved by all patients in cluster 3, by 86% of patients in cluster 2, by 63% of patients in cluster 1, and by 20% of patients in cluster 4. The differences between the groups were statistically significant ( P = .01). Conclusion: Arthroscopic surgery yielded good results in the treatment of stable borderline hip dysplasia with anterolateral and lateral deficiency. In contrast, borderline hip dysplasia with acetabular retroversion showed no improvements after arthroscopic therapy. This study underlines the need for an accurate analysis of all possible radiological signs to adequately classify borderline dysplastic hips.

scholarly journals Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip: A Systematic Review

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Yoichi Murata ◽  
Naomasa Fukase ◽  
Maitland Martin ◽  
Rui Soares ◽  
Lauren Pierpoint ◽  
...  
Keyword(s):  
Systematic Review ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Patient Characteristics ◽  
Developmental Dysplasia ◽  
Edge Angle ◽  
Center Edge ◽  
Lateral Center Edge Angle ◽  
Dysplasia Of The Hip ◽  
Center Edge Angle

Background: The treatment for borderline developmental dysplasia of the hip (BDDH) has historically been arthroscopic surgery or periacetabular osteotomy (PAO). As orthopaedic surgery is constantly evolving, a lack of comparison of outcomes for these 2 treatment methods could potentially be stalling the progression of treatment for patients with BDDH. Purpose: To evaluate the existing literature on patient characteristics, procedures, clinical outcomes, and failure rates for patients with BDDH and to determine whether PAO or hip arthroscopic surgery is a better treatment method for patients with BDDH. Study Design: Systematic review; Level of evidence, 4. Methods: Studies included were found using the following search words: “hip” and “borderline dysplasia,” “osteotomy” or “arthroscopy,” and “outcome” or “procedure.” Articles were included if they detailed participants of all sexes and ages, reported on isolated hips, and had patients diagnosed with BDDH. Results: A search was conducted across 3 databases, resulting in 469 articles for consideration, from which 12 total studies (10 on arthroscopic surgery and 2 on PAO) were chosen for a review. There were 6 studies that included patients with a lateral center-edge angle of 18° to 25°, while the remainder included patients with a lateral center-edge angle of 20° to 25°. All the studies reviewing arthroscopic surgery reported concomitant/accessory procedures, while the articles on the topic of PAO did not. It was determined that, whether treated using arthroscopic surgery or PAO, outcomes improved across all patient-reported outcome measures. Revision surgery was also common in both procedures. Conclusion: There is a lack of consensus in the literature on the best treatment option for patients with BDDH. Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes.

scholarly journals Successful Outcomes at Midterm Follow-up of Periacetabular Osteotomy Done for Mild Hip Dysplasia

2017 ◽  
Vol 01 (04) ◽  
pp. 167-172 ◽  
Author(s):  
G. Potter ◽  
Eduardo Novais ◽  
Robert Trousdale ◽  
Rafael Sierra
Keyword(s):  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Demographic Variables ◽  
Harris Hip Score ◽  
Control Group ◽  
Center Edge ◽  
Radiographic Measurements ◽  
Significant Difference

AbstractYoung hip surgeons are often faced with the decision to either perform arthroscopic surgery or a periacetabular osteotomy (PAO) in patients with symptomatic mild hip dysplasia (MHD). There is, however, a paucity of data on the results of PAO in this group. The aim of this paper is to report the results of PAOs in patients with MHD and compare those to hips with more severe forms of hip dysplasia (SHD). This data can then be used to compare emerging data reporting the results of hip arthroscopy for MHD. From January, 1996 to May, 2009, 299 hips in 268 patients were identified that underwent PAO at one institution. After removing those with <2 years of follow-up, 182 hips were followed up. The average age of the cohort was 31 years, and 85% were female. Nineteen hips with lateral center edge (LCE) angle from 18 to 25° and a Tönnis angle (TA) between 10 and 15° were considered to have MHD. This group was compared with the rest of the cohort (SHD). The mean clinical follow-up for the MHD group was 121 months. There was no significant difference in demographic variables between the groups. There were no complications in the MHD cohort. Surgical correction resulted in significant improvements in all radiographic measurements consistent with hip dysplasia in both groups. The Harris Hip Score (HHS) improved significantly in both groups ([MHD: 52–92] [SHD: 66–89]). Two hips (10.5%) in the MHD group and 15 hips (9.2%) in the SHD group underwent future THA (p = 0.69). The survivorship free from THA was 100%, 100%, and 86% at 3, 5, and 10 years, respectively, in the MHD group. The corresponding rates for hips in the control group at 3, 5, and 10 years, respectively, were 99%, 95%, and 81%. PAO in patients with MHD provides predictable improvements in pain, function, and results that are durable and comparable to hips with SHD. This data should be used to compare the early and midterm results of arthroscopic surgery performed in mildly dysplastic hips.

Can the FEAR Index Be Used to Predict Microinstability in Patients Undergoing Hip Arthroscopic Surgery?

2019 ◽  
Vol 47 (13) ◽  
pp. 3158-3165 ◽  
Author(s):  
Jeremy N. Truntzer ◽  
Daniel J. Hoppe ◽  
Lauren M. Shapiro ◽  
Marc R. Safran
Keyword(s):  
Arthroscopic Surgery ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Hip Instability ◽  
Radiographic Findings ◽  
Radiographic Parameters ◽  
Center Edge ◽  
Fear Index ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Atraumatic hip instability, or microinstability, is a challenging diagnosis for clinicians to make. Several radiographic parameters have been proposed to help identify patients with instability as a means to direct treatment. The Femoro-epiphyseal Acetabular Roof (FEAR) index was recently offered as a parameter to predict instability in a borderline dysplastic population. Purpose: To evaluate the FEAR index in a series of predominantly nondysplastic patients undergoing hip arthroscopic surgery to determine if it can accurately predict patients with diagnosed microinstability at the time of surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive series of 200 patients undergoing hip arthroscopic surgery were evaluated for microinstability intraoperatively. Microinstability was diagnosed based on previously published criteria. Retrospectively, radiographic parameters were measured including the lateral center edge angle of Wiberg (LCEA), Tönnis angle, physeal scar angle, and FEAR index. Patients were excluded if they previously had any type of bony procedures performed, underwent prior open hip surgery or total hip arthroplasty of the ipsilateral hip, had osteoarthritis (Tönnis grade >1), or had any radiographic features of moderate-to-severe acetabular dysplasia including an LCEA <18°. Results: After applying exclusion criteria, 167 hips in 150 patients were analyzed. Based on an intraoperative assessment, 96 hips (57.5%) were considered stable, and 71 hips (42.5%) had signs of microinstability (unstable group). Patients in the unstable group had fewer radiographic findings of femoroacetabular impingement and higher rates of borderline dysplasia. All 4 measured angles were found to have excellent interobserver agreement. The FEAR index was significantly more positive in the unstable group compared with the stable group (−7.8° vs −11.3°, respectively; P = .004). A more positive FEAR index was also found in patients meeting intraoperative criteria for instability, with the exception of chondral wear pattern. Unstable nondysplastic patients (LCEA ≥25°, Tönnis angle ≤10°) also were found to have higher FEAR index values (−9.0° vs −12.0°, respectively; P = .012). A FEAR index cut-off of −5.0° was associated with a specificity of 92.4% and accuracy of 69.4% for predicting instability in a nondysplastic population. Conclusion: The FEAR index was validated to improve the recognition of unstable patients preoperatively across a population with both borderline dysplastic and nondysplastic features.

scholarly journals Is hip arthroscopy useful for the treatment of borderline dysplasia? A case-controlled study

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
José I Oñativia ◽  
Pablo Slullitel ◽  
Agustín García Mansilla ◽  
Fernando Díaz Dilernia ◽  
Martín Buttaro ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Multivariate Regression ◽  
Hip Dysplasia ◽  
Osteochondral Lesions ◽  
Edge Angle ◽  
Center Edge ◽  
Group 2 ◽  
Center Edge Angle ◽  
Group 1

Introduction: The idyllic treatment of hip dysplasia is periacetabular osteotomy (PAO). Since the indication of arthroscopy as a unique action is controversial in the treatment of dysplasia, our objective was to analyze its clinical and radiological results in a cohort of patients with borderline dysplasia and compare them with controls with femoroacetabular impingement (FAI). Material and methods: We retrospectively analyzed a group of 29 patients with a labral lesion secondary to borderline hip dysplasia (group 1) and another group of 197 patients with FAI (group 2) treated with hip arthroscopy, evaluating reoperations and joint survival as the main outcomes. Only patients with both diagnoses treated with hip arthroscopy and with a minimum follow-up of 2 years were included. We excluded patients with coxa profunda, patients who only underwent labral debridement, revisions, cases with dysplasia initially treated with PAO and those with previous ipsilateral hip pathology such as local neoplasia, avascular necrosis, Perthes disease or epiphysiolysis. The diagnosis of borderline dysplasia was made radiologically, with a lateral center-edge angle greater than 18° but less than 25°. Among patients of group 1, the arthroscopic capsulotomy was minimal (punctate) and the iliofemoral ligament was always respected; thus, capsular plicature was not performed in any case. The average follow-up was 43 months, being 41 months for group 1 and 43 months for group 2 (p=0.33). Although there was a greater proportion Tönnis 2 of degenerative changes among patients with FAI (10%) than in the group with borderline dysplasia (0.5%), this difference was not significant (p=0.14). Both groups presented with a high prevalence of CAM type lesion (88% of the series). However, the mean radiological alpha angle value was higher in group 1 (61°) than in group 2 (57°) (p=0.002). The Tönnis angle was categorized as normal (0-10°) in all patients with borderline dysplasia and in 71% of the FAI group, but in the rest of the latter group it was less than 0° (p<0.001). The average Wiberg angle was 22° in group 1 and 34° in those with FAI (p<0.001); while the average anterior center-edge angle was 23° in the first group and 30° in the second (p <0.001). We performed a multivariate regression analysis to associate the need of reoperation with different demographic, radiological and intraoperative variables. Results: There were 7 complications among patients of group 2: a superficial wound infection medically treated; 3 cases of paresthesias in pudendal territory that resolved spontaneously in all cases at 3 months postoperatively; 1 deep vein thrombosis and 2 cases of heterotopic calcifications in patients who remained asymptomatic. No complications were recorded in the borderline dysplasia group. Thirty-eight percent of the series presented with osteochondral lesions detected during the arthroscopy (p=0.69). Of these, 42% were treated with microfractures (p=0.21) because they were classified as Outerbridge grade 4. Five patients in group 2 required a new surgical procedure. In 2 of them, the reoperation consisted of a controlled dislocation due to the progression of the size of their osteochondral lesions at 21 and 48 months of the initial procedure. Both cases presented an Outerbridge 4 osteochondral lesion greater than 0.5 cm2 in the initial arthroscopy. The remaining 3 cases were treated with a revision arthroscopy due to the persistence of their symptoms at a mean of 22 months postoperatively, due to an insufficient osteochondroplasty done at the first procedure. However, the rate of joint preservation was 100% since at the end of follow-up none of the patients had to be converted to total hip replacement. Although there were no reoperations in the borderline dysplasia group, this difference with group 1 was not statistically significant (p=0.38). The multivariate regression model adjusted for reoperation showed a very strong statistical association between the finding of osteochondral lesions and therapeutic failure, with a coefficient of 0.12 (p<0.001, CI95% = 0.06 - 0.17). In the same way, although the association was weak (p=0.04, CI95% = -0.4 - -0.01), the fact of resecting the CAM lesion behaved as protector for the model with a coefficient of -0.2. Conclusion: Hip arthroscopy was useful in the treatment of borderline dysplasia, without showing survival differences with the FAI group. We suggest indicating it carefully in the dysplasia, whenever the symptoms of FAI prevail over those of instability.

scholarly journals BORDERLINE DYSPLASIA: ARE THESE HIPS ONLY MILDLY UNCOVERED?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0013
Author(s):  
Michael McClincy ◽  
James Wylie ◽  
Yi-Meng Yen ◽  
Eduardo Novais
Keyword(s):  
Hip Arthroscopy ◽  
Periacetabular Osteotomy ◽  
Edge Angle ◽  
Radiographic Parameters ◽  
Center Edge ◽  
Hip Morphology ◽  
Acetabular Deficiency ◽  
Fear Index ◽  
Cam Morphology ◽  
Center Edge Angle

Background: Controversy surrounds classification and treatment of hips with a lateral center-edge angle (LCEA) between 18° and 25°. It remains undetermined as to whether open or arthroscopic procedures are best used to treat patients with borderline dysplasia. We hypothesized that patients with hip pain and borderline acetabular dysplasia have different features of acetabular morphology as determined by other relevant radiographic measures beyond the LCEA. Methods: A retrospective review of patients undergoing hip preservation surgery between January 2010 and December 2015 with either periacetabular osteotomy(PAO) or hip arthroscopy with a LCEA between 18° and 25° was performed. Anteroposterior, Dunn lateral and false profile radiographs were used to measure LCEA, Tönnis Angle, anterior center edge angle (ACEA), anterior (AWI) and posterior (PWI) wall indexes, the femoral epiphyseal acetabular roof (FEAR) index, joint space width, crossover sign, posterior wall sign, P/A index, and femoral alpha angle. An agglomerative hierarchical clustering analysis was then performed on the continuous radiographic variables to identify different subtypes of hip pathomorphology among this patient cohort. There were sex-specific trends in hip morphology. Therefore, we proceeded to perform separate cluster analyses for each sex. Results: Ninety-nine patients underwent surgery in the study period, 77 (78%) were female, and 81 (82%) of these had complete radiographic images for cluster analysis. Mean age was 22.6 years. Hip arthroscopy was performed in 41% of patients and periacetabular osteotomy was performed in 59% of patients. The ACEA (45%), FEAR Index (34%), and AWI (30%) were the most commonly abnormal radiographic parameters among all patients. In female patients, the ACEA (55%), FEAR Index (42%), and AWI (34%) were the most commonly abnormal radiographic parameters. In male patients, an insufficient PWI (48%) was the most common radiographic abnormality. For females, we identified three clusters representing different patterns of hip morphology: impingement morphology; lateral acetabular deficiency, and anterolateral acetabular deficiency (Table 1A). For males, we identified three clusters: postero-lateral acetabular deficiency with global cam morphology, postero-lateral acetabular deficiency with focal cam morphology, and lateral acetabular deficiency without cam morphology (Table 1B). Conclusions: A comprehensive evaluation of radiographic parameters in patients with LCEA 18-25° identifies sex-specific trends in hip morphology and shows a large proportion of dysplastic features among these patients. A thorough evaluation of all pelvic morphology, not just lateral coverage, should be considered when indicating these patients for hip preservation surgeries. Further studies are needed to investigate the outcomes of patients within each of the identified clusters to determine optimal treatment options for each group. [Table: see text][Table: see text]

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