ePoster #102 - ISHA Annual Scientific Meeting 2016

Combined Hip Arthroscopy and Peri-Acetabular Osteotomy: Intra-Articular Pathology

Raymond James Kenney, MD, Rochester, NY UNITED STATES
Kelly Lynne Adler, MEd, ATC, Pittsford, NY UNITED STATES
Christopher Cook, MD, Rochester, NY UNITED STATES
Brian D. Giordano, MD, Rochester, NY UNITED STATES

University of Rochester Medical Center, Rochester, NY, UNITED STATES

FDA Status Not Applicable

Summary: The purpose of this study was to further delineate the types and rate of intra-articular pathology in a large series of patients who have undergone combined Hip Arthroscopy and PAO at a high volume hip preservation center.

Abstract:
Background: Previous studies have reported patient reported outcomes, complications and intra-articular pathology in small series of patients who have undergone hip preservation surgery. Various types of intra-articular pathology have been previously reported in up to 100% of patients undergoing combined Hip Arthroscopy and Peri-acetabular Osteotomy (PAO). Purpose: The purpose of this study was to further delineate the types and rate of intra-articular pathology in a large series of patients who have undergone combined Hip Arthroscopy and PAO at a high volume hip preservation center. Methods: A review was conducted to determine types and rate of intra-articular pathology for 73 consecutive patients (76 hips) who underwent combined Hip Arthroscopy and PAO at a single academic medical center from June 2012 through February 2016. Charts were reviewed for operative records describing intra-articular pathology encountered at the time of Hip Arthroscopy. Results: Electronic medical records of 73 consecutive patients (76 hips) who underwent combined Hip Arthroscopy and PAO were reviewed. Chondromalacia of the acetabulum was documented in all 76 hips (100%) most commonly in geographic zones 2 and 3. Labral tear was noted in 62 patients (82%). Ligamentum teres tear was documented on 50 patients (66%). Femoral acetabular impingement (FAI) morphology was documented in 64 patients (84%). Mixed FAI was most common (43 patients, 57%), followed by isolated cam (17 patients, 22%) and focal pincer type acetabular rim prominence (4 patients, 5%). Synovitis was documented in 70 patients (92%) and loose bodies were documented and removed in 37 patients (49%). Loose bodies largely represented chondral fragments, focal labral calcifications, or acetabular rim fractures. Conclusion: In a large series of patients with acetabular dysplasia undergoing combined Hip Arthroscopy and PAO, a high rate of coexistent intra-articular pathology was identified. This corresponds with prior studies and previously published reports. Traditional arthrotomy may offer a more limited window into the central compartment, and subsequently fail to address potentially treatable intra-articular pathology. Separate studies are focused on the use of combined Hip Arthroscopy and PAO clinical outcomes through a more comprehensive approach to treating both intra-articular pathology and structural malalignment.