Hip Pelvis.  2019 Jun;31(2):102-109. 10.5371/hp.2019.31.2.102.

Hip Arthroscopy of a Painful Hip with Borderline Dysplasia

• Yoon SJ
• Lee SH
• Jang SW
• Jo S

• KMID: 2448029
• DOI: http://doi.org/10.5371/hp.2019.31.2.102

Abstract

PURPOSE
Hip arthroscopy has been considered for treating hip dysplasia; however, its efficacy is still a matter of controversy. Here, we report outcomes of patients with borderline dysplasia treated with a contemporary hip arthroscopy technique.
MATERIALS AND METHODS
Forty-seven hips with borderline hip dysplasia were treated using hip arthroscopy. Patients underwent procedures to correct torn labrums or ligamentum teres with additional procedure on the acetabular capsule. Patient outcomes were assessed using visual analogue scale (VAS), modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS) and patient satisfaction. Risk factors for poor prognosis were also investigated.
RESULTS
The mean follow up period was 25.9 months. At the last follow up, mean VAS score decreased from 6.1±1.6 to 3.5±2.8 (P=0.016). The mHHS and NHAS at the last follow up improved from 61.0±7.6 to 78.6±19.5 (P=0.001) and 62.1±7.5 to 80.0±18.5 (P=0.002), respectively. While significant improvement was observed in all patient reported outcome measures tested, 19 (40.4%) hips indicated that "the operation was unsatisfactory." The only factor shown to influence outcomes was preoperative VAS (i.e., worse scores potentially an indicator of poor outcomes).
CONCLUSION
The results of the current study indicate that arthroscopic management may be beneficial for a subset of patients with borderline dysplasia; however, the dissatisfaction rate associated with this treatment approach may be as high as 40%. The poor preoperative pain score appears to be the sole indicator for poor outcomes.

Keyword

Arthroscopy; Borderline dysplasia; Capsule; Labrum; Round ligament

MeSH Terms

Acetabulum
Arthroscopy*
Follow-Up Studies
Hip Dislocation
Hip*
Humans
Outcome Assessment (Health Care)
Patient Satisfaction
Prognosis
Risk Factors
Round Ligaments

Figure

• 

  Fig. 1 Arthroscopic findings of a borderline dysplastic hip. (A) Tear (black arrow) of hypertrophied labrum (L) with chondral delamination (arrowhead). (B) Ligamentum teres (LT) partial tear (white arrow).A: acetabulum, FH: femoral head.

• 

  Fig. 2 (A) A 47-year-old female with a painful left side hip revealing lateral center edge angel of 24°. (B) Labral tear (black arrow) was noted with cartilage degeneration (arrowhead) which was treated with. (C) Labral repair using mattress suture and (D) capsular plication. (E) The patient did not achieve satisfactory results, instead developed osteoarthritis at 1 year follow up.A: acetabulum, FH: femoral head, FN: femoral neck, L: labrum.

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