ePoster #105 - ISHA Annual Scientific Meeting 2016

Complication Rates of Combined Hip Arthroscopy and Periacetabular Osteotomy for the Treatment of Acetabular Dysplasia: Review of 142 Consecutive Cases

Jeffrey J. Nepple, MD, St. Louis, MO UNITED STATES
Gopal Lalchandani, MD, St. Louis, MO UNITED STATES
Rafael J. Sierra, MD, Rochester, MN UNITED STATES
Casey Dedeugd, MD, Rochester, MN UNITED STATES
John Clohisy, MD, St. Louis, MO UNITED STATES

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

FDA Status Cleared

Summary: Major complication rates of combined hip arthroscopy and PAO are acceptable (2.8%) and similar to previously reported complication rates of PAO alone.

Abstract:
Background: Hip arthroscopy is increasingly utilized as an adjunct to periacetabular osteotomy (PAO) in patients with symptomatic acetabular dysplasia. Hip arthroscopy allows for precise treatment of intra-articular chondrolabral pathology not easily accessed during PAO. However, the addition of hip arthroscopy to the PAO increased surgical time and fluid extravasation into the soft tissues that could increase complication rates. Major complication rates of PAO alone have been shown to be 5.9%. The purpose of our current study was to determine the rates of complication of combined hip arthroscopy and PAO.

Methods: A prospective hip preservation database was reviewed to identify all patients undergoing combined hip arthroscopy and PAO during the seven year study period. In all cases, hip arthroscopy was performed for treatment of intra-articular chondrolabral pathology. PAO was then performed in the same setting, generally including an arthrotomy for performing a proximal femoral osteoplasty in the open exposure. Retrospective review of inpatient and outpatient medical records was performed to identify complications. Complications were graded according to the modified Dindo-Clavien complication and Grade 3 or 4 complications (indicating need for associated medical or surgical treatment) considered in the current study.

Results: One hundred and forty-two hips (134 patients) underwent combined hip arthroscopy and PAO, including 117 females (87.3%) and 17 males (12.7%) with a mean age of 27.6 years. Median duration of surgery was 209 minutes, with a median estimated blood loss of 350 mL. Labral repair was performed in 95 hips (66.9%), while labral debridement was performed in 7 additional hips (4.9%). Acetabular chondroplasty was performed in 44 hips (31.0%), while debridement of the ligamentum teres was performed in 25 hips (17.6%). Grade 3 complications occurred in 2.8% of patients (n=4), while no Grade 4 complications occurred. Grade 3 complications included deep infection (n=1), hematoma requiring exploration (n=1), symptomatic heterotopic ossification requiring excision (n=1), and deep venous thrombosis (n=1).

Conclusions: Major complication rates of combined hip arthroscopy and PAO are acceptable (2.8%) and similar to previously reported complication rates of PAO alone. Further research is needed to better define the role of combined hip arthroscopy and PAO in the outcomes of treatment of acetabular dysplasia.