ePoster #725 - ISHA Annual Scientific Meeting 2016

Hip Arthroscopy in Patients with Mild to Moderate Dysplasia: When Do They Fail?

Andrew John Bryan, MD, Rochester, MN UNITED STATES
Kirsten Poehling Monaghan, MD, Rochester, MN UNITED STATES
Rohith Mohan, BA, Rochester, MN UNITED STATES
Nick R Johnson, BS, Rochester, MN UNITED STATES
Aaron J. Krych, MD, Rochester, MN UNITED STATES
Bruce A. Levy, MD, Rochester, MN UNITED STATES
Robert Trousdale
Rafael J. Sierra, MD, Rochester, MN UNITED STATES

Mayo Clinic, Rochester, MN, UNITED STATES

FDA Status Not Applicable

Summary: In hips with dysplasia undergoing arthroscopic treatment, patients with poor outcome were more likely to have an LCEA less than 17 and intraoperative rim resection. In those hips doing well at short to mid-term follow-up, careful longer-term followup is needed to determine whether these improvements in pain and function are maintained.

Abstract:
Background The role of arthroscopic treatment for hip dysplasia remains undefined. The purpose of this study is to compare a group of dysplastic hips treated successfully with hip arthroscopy to a failed group to determine 1) pre-operative patient characteristics and radiographic parameters and 2) intra-operative treatment associated with outcome. Methods: We retrospectively reviewed a prospective database of 20 adult patients (17F: 3M) with hip dysplasia who underwent primary hip arthroscopy between January 2009 and February 2013. Surgical outcome data as well as preoperative and postoperative radiographic measurements (including alpha, Tonnis and lateral center edge angles [LCEA]) were compared between patients who failed hip arthroscopy (11 patients) and those who did not (9 patients). Failure after hip arthroscopy was defined as a modified Harris Hip Score (mHHS) < 80 or need for subsequent hip arthroscopy, arthroplasty or periacetabular osteotomy (PAO). Results The mean follow-up for the successful patients was 58 months (37-82 months) with average modified Harris Hip Score (mHHS) of 93 at most recent follow-up. In the failure group, average time to failure occurred at 23 months, with 7 PAOs, 2 THAs, 1 revision hip arthroscopy, and 1 hip with a low mHHS that had not undergone further surgery. Preoperative radiographs demonstrated a lower LCEA (18 vs 21; p=0.02) in the failure group and the LCEA was predictive of success, with all successes occurring with a LCEA of 17 or greater. The failure group was also more likely to have had rim resection performed intraoperatively (HR 3.53; p=0.04). Conclusion In hips with dysplasia undergoing arthroscopic treatment, patients with poor outcome were more likely to have an LCEA less than 17 and intraoperative rim resection. In those hips doing well at short to mid-term follow-up, careful longer-term followup is needed to determine whether these improvements in pain and function are maintained.