Paper #34 - ISHA Annual Scientific Meeting 2016

Endoscopic Shelf Acetabuloplasty After Failed Hip Arthroscopic Labral Repair And Capsular Closure In Patients With Developmental Dysplasia Of The Hip.

Shiho Kanezaki, MD, PhD, Kitakyushu JAPAN
Hirotaka Nakashima, MD, Kitakyushu JAPAN
Akihisa Hatakeyama, MD, Kitakyushu JAPAN
Yoichi Murata, MD, Kitakyushu JAPAN
Soshi Uchida, MD, PhD, Kitakyushu, Fukuoka JAPAN

Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, JAPAN

FDA Status Not Applicable

Summary: Endoscopic shelf acetabuloplasty could provide favorable clinical outcomes following failed arthroscopic labral repair in patients with DDH and borderline DDH.

Abstract:
Background and purpose Hip arthroscopic labral preservation (repair or reconstruction) is increasingly defined as an unacceptable tool for treating developmental dysplasia of the hip (DDH). We devised new entirely endoscopic shelf acetabuloplasty for treating patients with DDH. However, there is a dearth of knowledge regarding how the results of endoscopic shelf acetabuloplasty is affected by a prior hip arthroscopic labral preservation in the presence of underlying DDH. The purpose of this study was to clarify clinical outcomes following endoscopic shelf acetabuloplasty after failed hip arthroscopic labral repair in patients with DDH. Materials and Methods Between January 2012 and December 2013, 10 hips in 9 symptomatic patients of DDH and borderline DDH (center edge (CE) angle< 25 degree) were poor outcome of arthroscopic labral repair and underwent subsequent endoscopic shelf acetabuloplasty. The mean age of them at the time of subsequent surgery was 42.5 (range, 25-61) years. The mean follow-up period was 2.6 years (range, 32-42 months). Modified Harris hip score (mHHS) and non-arthritic hip score (NAHS) were utilized to evaluate clinical hip function. We assessed plain radiograph and evaluate severity of osteoarthritis by using Tonnis grade. Preoperative mHHS was 56.9 (range, 18.7-77.0) and NAHS was 43.9 (range, 36.0-55.0). Eight hips were Tonnis grade 0, two hips were Tonnis grade 1, and one hip was Tonnis grade 2 preoperatively. For acetabular index, the mean CE angle was 17.8±3.6 (range, 9.0-23.0) degree, Sharp angle was 44.9±2.8 (range, 40.0-50.0) degree, Tonnis angle was 13.4±4.9 (range, 1.6-21.0) degree, and VCA angle was 15.9±7.5 (range, -3.0-24.0). Results CE angle was improved to 43.3±10.1 degree postoperatively (p< 0.05, Wilcoxon signed-rank test), and 33.3±8.2 degree (p< 0.05, Wilcoxon signed-rank test) one year after surgery. The severity of osteoarthritis at the final follow-up was as follows, 7 hips for Tonnis grade 0, one hip for 1, and two hips for 2. The mean mHHS improved to 90.5 (range, 77.0-100.0) at the final-follow up (p< 0.05, Wilcoxon signed-rank test). The mean NAHS improved to 60.9 (range, 39.0-74.0) at the final-follow up (p< 0.05, Wilcoxon signed-rank test). Conclusion Endoscopic shelf acetabuloplasty could provide favorable clinical outcomes following failed arthroscopic labral repair in patients with DDH and borderline DDH.