ePoster #103 - ISHA Annual Scientific Meeting 2016

Early Clinical and Radiographic Outcomes of Combined Hip Arthroscopy and Periacetabular Osteotomy: Results of 85 Consecutive Cases

Jeffrey J. Nepple, MD, St. Louis, MO UNITED STATES
James R. Ross, MD, Deerfield Beach, FL UNITED STATES
Ira Zaltz, MD, Royal Oak, MI UNITED STATES
John Clohisy, MD, St. Louis, MO UNITED STATES

Washington University School of Medicine, St. Louis, MO, UNITED STATES

FDA Status Cleared

Summary: At short-term follow-up, hip arthroscopy with PAO shows equal improvement in clinical outcomes with similar radiographic changes when compared to PAO alone.

Abstract:
Background: Modern treatment of hip dysplasia has focused on the correction of the structural deformity with the periacetabular osteotomy (PAO), which addresses the deformity by redirecting the acetabulum into an improved anatomic position. Hip arthroscopy has allowed an increased awareness of the intra-articular pathology associated with acetabular dysplasia. The combination of hip arthroscopy with periacetabular osteotomy allows for treatment of both intra-articular and structural abnormalities associated with hip dysplasia. However, there is limited information regarding this combined approach for treating symptomatic acetabular dysplasia and its associated intra-articular abnormalities.
Hypothesis/Purpose: The purpose of this study was to report the early clinical and radiographic outcomes of combining hip arthroscopy with PAO in selected patients with symptomatic acetabular dysplasia.
Study Design: Level 3
Methods: We retrospectively reviewed 85 consecutive hips (81 patients) that underwent hip arthroscopy combined with a periacetabular osteotomy (HS-PAO). A comparison group of 139 hips (120 patients) who underwent PAO alone were also analyzed. The minimum clinical follow-up of the HS-PAO group was 12 months (mean, 26 months; range, 12-78 months). Pre-operative and post-operative standardized radiographs were analyzed for findings of acetabular dysplasia, including lateral center-edge angle (LCEA), acetabular inclination, anterior-center edge angle (ACEA), and Tönnis osteoarthritis grade. Clinical outcomes were evaluated with the UCLA activity score, modified Harris hip score (mHHS), short form-12 (SF-12), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Perioperative complications were graded.
Results: The mean age of the patients in the HS-PAO group was 28.7 years (range, 12 to 49 years), which was slightly older than the comparison group (mean age 25.6 years; p = 0.03). Seventy-five hips (92%) were in female patients, and 56% were right-sided. There was significant change in the mean LCEA (16.0° vs. 29.2°; p < 0.0001), acetabular inclination (15.2° vs. 3.9°; p < 0.0001), and ACEA (18.2° vs. 30.7°; p <0.0001). The preoperative UCLA, SF-12 physical, and SF-12 mental scores were not significantly different between groups, while the PAO-HS group had a lower mHHS and higher WOMAC scores. The PAO-HS saw improvements in all clinical scores, while the PAO alone group saw significant improvements in the mHHS, SF-12 Physical, WOMAC Pain, Stiffness, Function, and Total Scores. The PAO alone group did not have a significant improvement in the UCLA activity or the SF-12 mental scores.
Conclusions: At short-term follow-up, hip arthroscopy with PAO shows equal improvement in clinical outcomes with similar radiographic changes when compared to PAO alone. Selected patients who underwent a combined hip arthroscopy and PAO had more pain and dysfunction pre-operatively. These patients also experienced a significant improvement in the activity level.