Paper #27 - ISHA Annual Scientific Meeting 2016

Does Previous Hip Arthroscopy Impact the Clinical Outcomes of PAO Surgery? An ANCHOR Cohort Study

Benjamin Coob, MD, Roanoke, VA UNITED STATES
Jeffrey J. Nepple, MD, St. Louis, MO UNITED STATES
Geneva Baca, BA, St. Louis, MO UNITED STATES
Anchor Group, MD, St. Louis, MO UNITED STATES
John Clohisy, MD, St. Louis, MO UNITED STATES

Washington University School of Medicine, Saint Louis, MO, UNITED STATES

FDA Status Not Applicable

Summary: Treatment of acetabular dysplasia with hip arthroscopy alone may not correct the abnormal pathomechanics of the hip, and can be associated with recurrent or persistent symptoms. Some patients may be best treated by undergoing the most comprehensive surgical strategy from the onset, thus avoiding multiple procedures on the same hip and poorer expected clinical outcomes.

Purpose: Hip arthroscopy (HS) alone in the setting of acetabular dysplasia remains controversial. Failure to address the abnormal pathomechanics of the hip may lead to persistent or recurrent symptoms. Subsequent periacetabular osteotomy (PAO) may be needed to correct the underlying structural abnormality. The impact of failed hip arthroscopy on a subsequent PAO has not been fully defined. Our purpose was to analyze the clinical results of PAO surgery for the treatment of acetabular dysplasia in patients with a history of failed HS and compare these to a matched control of hips treated with PAO as the index procedure but having had no prior HS.

Methods: A prospective, multicenter hip preservation database of over 3175 procedures was queried to identify patients with acetabular dysplasia who underwent a PAO after a failed HS. Fifty-one patients/hips were identified from 2008 through December 2012. Demographic, radiographic measures and patient reported outcomes [modified Harris Hip score (mHHS), UCLA and WOMAC] were reviewed. These results were then compared to a 2:1 matched control group of patients that underwent PAO without prior HS.

Results: The average clinical follow-up was 24.2 months and average 20 months between the failed hip arthroscopy and PAO. A majority are female (94%) and Caucasian (90%) patients with an average age of 25.4 and BMI 23.4. The average LCEA improved from 14.7°to 32.2°, AI from 16.1° to 3.8°, ACE angle from 16° to 35°. All patient reported outcomes improved. UCLA activity score improved from 5.7 to 7.1 (p = 0.0014) and the mHHS improved from 55.8 to 79.3 (p < 0.0001). WOMAC normative subscales improved including pain from 51.7 to 81.1 (p < 0.0001), stiffness from 52 to 75.7 (p < 0.0001), physical function from 59.7 to 86.4 (p < 0.0001) and total score from 57.9 to 84.7 (p < 0.0001).

Conclusions: These data suggest that after failed HS, a subsequent PAO can provide clinically significant improvements in pain, function and activity. However, the overall improvement following PAO in the setting of prior HS was statistically worse when compared to a matched control group of patients treated with PAO as the index procedure.