ePoster #903 - ISHA Annual Scientific Meeting 2016
Catastrophic Failure After Endoscopic Shelf Acetabuloplasty for Moderate Acetabular Dysplasia
Kiyokazu Fukui, MD, PhD, Kahoku-gun JAPAN
Ayumi Kaneuji, MD, PhD, Kahoku-Gun JAPAN
Norio Kawahara, MD, PhD, Prof., Kahoku-Gun JAPAN
Tadami Matsumoto, MD, PhD, Kahoku-Gun JAPAN
Kanazawa Medical University, Kahoku-gun, JAPAN
FDA Status Not Applicable
Summary: We report four cases of rapidly progressive osteoarthritis in which total hip replacement was required after endoscopic shelf acetabuloplasty was performed.
Introduction: A technique called endoscopic shelf acetabuloplasty was recently proposed for treating acetabular dysplasia [Uchida S, Wada T, Sakoda S, et al. Endoscopic shelf acetabuloplasty combined with labral repair, cam osteochondroplasty, and capsular plication for treating developmental hip dysplasia. Arthroscopy Techniques. 2014;3(1):e185–e191. doi:10.1016/j.eats.2013.09.013]. Although the procedure is attractive because it is less invasive than periacetabular osteotomy, outcomes for it have not been reported.
Patients and Methods: We reviewed data for four patients (three women and one man) who had moderate acetabular dysplasia and underwent endoscopic acetabuloplasty with arthroscopic labral repair. The average age at arthroscopic surgery was 43 years (range, 36 to 49 years). The average center-edge angle of Wiberg was 10° (range, 8° to 11°). Although three of the four patients already had mild osteoarthritic changes, including joint-space narrowing documented on radiographs, a space of >2 mm was maintained in all four patients. During surgery, we found degenerative inversion of the anterosuperior portion of the labrum in all four patients. We resected only the inverted portion and fixed the remnant to the acetabular rim using anchor sutures (3 to 4 sutures) before performing acetabuloplasty. One male patient also underwent osteochondroplasty to repair a cam deformity.
Results: All four patients required THR within 2 years of arthroscopy because of rapidly progressive osteoarthritis and increasing pain. The average period from arthroscopy to total hip replacement was 11 months (range, 9 to 20 months).
Discussion and Conclusion: There are several reasons for the catastrophic failures in our study; however, we believe that hip surgeons should keep in mind that endoscopic shelf acetabuloplasty is a technically demanding procedure and that strict patient selection is thus crucial for a successful outcome. Although acetabuloplasty is less invasive than periacetabular osteotomy for patients with hip dysplasia, it not only may fail to provide symptomatic improvement but also may make total hip replacement a necessity sooner than expected.