ePoster #116 - ISHA Annual Scientific Meeting 2016

Hip Arthroscopy in Adolescent Patients: The Impact of Skeletal Maturity on Hip Pathology and Treatment

Aman Sharma, MS, Winston-Salem, NC UNITED STATES
Alejandro Marquez-Lara, MD, Winston Salem, NC UNITED STATES
T. David Luo, MD, Winston-Salem, NC UNITED STATES
Elizabeth A. Howse, MD, Walnut Creek, CA UNITED STATES
Sandeep Mannava, MD, PhD, Winston Salem, NC UNITED STATES
Austin V. Stone, MD, PhD, Winston-Salem, NC UNITED STATES
Allston J. Stubbs, MD, MBA, Winston Salem, NC UNITED STATES

Wake Forest University School of Medicine, Winston-Salem, North Carolina, UNITED STATES

FDA Status Not Applicable

Summary: This retrospective chart review demonstrated that among teenagers undergoing hip arthroscopy, skeletal maturity was a significant predictor for requiring acetabuloplasty. Patients who had not reached skeletal maturity at the time of surgery demonstrated limited range of motion. Further research is warranted to define the role of hip arthroscopy in adolescents who have not reached skeletal maturity

Abstract:
Introduction: Improvement in diagnostic imaging and surgical techniques have expanded the indications for arthroscopic management of hip conditions in adolescent patients. Although studies have demonstrated encouraging outcomes in younger patients, the impact of skeletal maturity on hip pathology has not been well characterized. The purpose of this study is to assess how skeletal maturity relates to the clinical presentation and hip pathology treated during hip arthroscopy.

Methods: A database of 791 patients who underwent hip arthroscopy by a single surgeon between 2008 and 2015 was queried. Adolescent patients (age <18 years old) were selected and stratified by skeletal maturity (mature vs. immature) based on Risser score assessed on anterior-posterior pelvis plain film radiograph. Patients with Risser scores of = 4 were defined as skeletally immature. Patients with a diagnosis of hip dysplasia were excluded. Patient demographics, clinical presentation, physical exam findings, pre-operative diagnostic imaging studies and arthroscopic interventions were assessed. Chondromalacia severity index (CMI) was calculated as a product of the Outerbridge chondromalacia grade (I to IV) and effected surface area (mm2*severity). Groups were compared using chi-squared and Student T-test for categorical and continuous variables, respectively. Logistic regression analysis was performed with a 95% CI to determine the relationship between skeletal maturity and hip pathology. A p-value of =0.05 denoted statistical significance.

Results: A total of 63 patients, of which 38 (60.3%) were skeletally immature, were included in the analysis. There were no significant differences in patient demographics, pain with activity, duration of symptoms, and pathologic findings on diagnostic imaging studies between groups However, skeletally mature patients more often complained of anterior hip pain (100% vs 87.0%, p=0.018) and reported greater narcotic consumption (55.0% vs. 13.3%) compared to skeletally immature patients. Furthermore, skeletally immature patients demonstrated limited internal hip rotation on both the operative (9.9±12.4 vs 16.0±10.3 degrees, p=0.045) and non-operative side (19.8±13.6 vs 30.9±21.4 degrees, p=0.015). There were no significant differences in chondral lesion severity between groups. However, regression analysis demonstrated that skeletally mature patients had greater odds of undergoing acetabuloplasty (OR: 3.8, 95%CI 1.1-14.4, p=0.05) relative to skeletally immature patients.

Discussion and Conclusion: Adolescent patients who underwent hip arthroscopy presented with similar clinical symptoms and diagnostic imaging findings, regardless of skeletal maturity. However, the findings from this study suggest that adolescent patients who are skeletally mature at the time of hip arthroscopy are more likely to use narcotics and undergo arthroscopic acetabuloplasty. Interestingly, skeletally immature patients demonstrated limited internal rotation compared to those who were skeletally mature, but range of motion did not appear to be associated with distinct hip pathology or arthroscopic treatment. As the indications for hip arthroscopy continue to expand in adolescent patients, further research is warranted to better define the role of hip arthroscopy for individuals who have not yet reached skeletal maturity.