Abstract
The outcomes of hip arthroscopy in the treatment of dysplasia are variable. Historically, arthroscopic treatment of severe dysplasia (lateral center-edge angle [LCEA] < 18°) resulted in poor outcomes and iatrogenic instability. However, in milder forms of dysplasia, favorable outcomes have been reported. The purpose of this study was to compare outcomes following hip arthroscopy for femorocetabular impingement (FAI) in borderline dysplastic (BD) patients compared with a control group of non-dysplastic patients.
Between March 2009 and July 2012, a BD group (LCEA 18°–25°) of 46 patients (55 hips) was identified. An age and sex-matched control group of 131 patients (152 hips) was also identified (LCEA 25°–40°). Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), the Sport-specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected pre-operatively, at 1, and 2 years.
The mean LCEA was 22.4 ± 2.0° (range, 18.4°–24.9°) in the BD group and 31.0 ± 3.1° (range, 25.4°–38.7°) in the control group (p<0.001). The mean preoperative alpha angle was 66.3 ± 9.9° in the BD group and 61.7 ± 13.0° in the control group (p=0.151). Cam decompression was performed in 98.2% and 99.3% of cases in the BD and control groups. Labral repair was performed in 69.1% and 75.3% of the BD and control groups respectively, with 100% of patients having a complete capsular closure performed in both groups. At a mean follow-up of 31.3 ± 7.6 months (range, 23.1–67.3) in unrevised patients and 21.6 ± 13.3 months (range 4.7–40.6) in revised patients, there was significant improvement (p<0.001) in all patient reported outcome scores in both groups. Multiple regression analysis did not identify any significant differences between groups. Importantly, female sex did not appear to be a predictor for inferior outcomes. Two patients (4.3%) in the BD group and six patients (4.6%) in the control group required revision arthroscopy during the study period.
Favorable outcomes can be expected following the treatment of impingement in borderline dysplastics when labral refixation and capsular closure are performed, with comparable outcomes to non-dysplastic patients. Further follow-up in larger cohorts is necessary to prove the durability and safety of hip arthroscopy in this challenging group and to further explore potential gender-related differences in outcome.
