ePoster #1005 - ISHA Annual Scientific Meeting 2016

Arthroscopic Treatment Of Labral Tears Of The Hip In Adolescents: Patterns Of Clinical Presentation, Intra-Articular Derangements, Radiological Associations And Minimum Two-Year Outcomes.

Sivashankar Chandrasekaran, MBBS, FRACS, Westmont, IL UNITED STATES
Nader Darwish, BS, Chicago, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Parth Lodhia CANADA
Carlos Suarez Ahedo, MD, Mexico City, DF MEXICO
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: This study aimed to report on patterns of clinical presentation, intra-articular derangements, radiological associations and minimum two-year outcomes following hip arthroscopy in patients = 18 years of age; this study found significant improvement in outcomes in this age group, as well as significant differences in labral tear pattern and surgical procedures based on gender.

Abstract:
Purpose: The purpose of this study was to report on patterns of clinical presentation, intra-articular derangements, radiological associations and minimum two-year outcomes following hip arthroscopy in patients = 18 years of age. Methods: This study was a retrospective case series on patients = 18 years who had undergone hip arthroscopy for treatment of labral tears that had failed non-operative management during the study period from April 2008 to April 2013 with a minimum two year follow up. The exclusion criteria were patients with a history of previous hip conditions or hip surgery. The following were recorded in the study population: demographic, examination, radiological and intra-operative findings, intra-operative procedures performed, patient reported outcomes (PROs) and patient satisfaction. The PROs reported included the modified Harris Hip Score (mHHS), Non Arthritic Hip Score (NAHS), Hip Outcome Score Sport Specific Subscale (HOS-SSS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Visual Analogue Score (VAS) for pain. Results: 102 patients satisfied the inclusion criteria for the study of which 90 (88.2%) had minimum two-year follow-up. There were 77 females and 13 males. Females had increased external rotation in flexion (58.9 degrees versus 50.0 degrees p=0.041). 68 females had a Beightons score of greater than 4 compared to 6 males (p<0.001). There was no distinct pattern within the group or between genders for radiological markers of acetabular coverage, depth or version and femoral cam size. Mean femoral anteversion for females was 15.70 and males 11.30. Females had significantly smaller labral tears (1.73 hours versus 2.34 hours on the acetabular clockface p=0.028). Females were more likely to require a capsular plication and iliopsoas fractional lengthening (88.3% versus 46.2%, and 77.9% versus 38.5%, respectively). There was a significant improvement in all PROs measures in both males and females (p<0.01) but females had lower preoperative and post-operative scores. Mean preoperative and postoperative PROs for males were – mHHS 71.0 and 94.3, HOS-ADLs 78.1 and 93.4, HOS-SSS 51.7 and 91.0, NAHS 78.1 and 94.5 and VAS 4.77 and 1.85. Mean preoperative and postoperative PROs for females were – mHHS 63.4 and 88.8, HOS-ADLs 64.0 and 91.8, HOS-SSS 45.7 and 78.6, NAHS 63.1 and 89.2 and VAS 6.29 and 2.21. Mean patient satisfaction score was 8.29 out of 10. Five patients (5.56%) required a revision procedure. Conclusion: Hip arthroscopy is associated with an improvement in outcomes and pain and high satisfaction scores at minimum two-year follow-up in adolescent population. The pattern of labral injury is different in males and females and dictates the arthroscopic approach. Females are likely to require a capsular plication and iliopsoas release to address soft tissue laxity and impingement.