ePoster #1201 - ISHA Annual Scientific Meeting 2016
Minimum Two-Year Outcomes of Hip Arthroscopy in Patients with Acetabular Over Coverage and Profunda Acetabulae in Comparison to a Matched Control with Normal Acetabular Coverage
Sivashankar Chandrasekaran, MBBS, FRACS, Westmont, IL UNITED STATES
Nader Darwish, BS, Chicago, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Carlos Suarez Ahedo, MD, Mexico City, DF MEXICO
Parth Lodhia CANADA
Benjamin G. Domb, MD, Chicago, IL UNITED STATES
American Hip Institute, Westmont, IL, UNITED STATES
FDA Status Not Applicable
Summary: Hip arthroscopy in patients with combined over coverage and coxa profunda is associated with improvements in patient outcomes and pain at minimum two-year follow-up; however, the degree of improvement is of lower magnitude compared to matched cohort with normal coverage.
Purpose: The purpose of this study was to report on patterns of clinical presentation and intra-articular derangements, radiological associations and minimum two-year outcomes following hip arthroscopy in patients with a lateral center edge angle (LCEA) > 400 and profunda acetabulae (PA) in comparison to a matched control with normal acetabular coverage.
Hypothesis: Advancements in hip arthroscopy have led to improved techniques in the management of global acetabular over coverage, which should lead to comparable outcomes to hip arthroscopy in those patients with normal coverage.
Methods: Data was collected on all patients undergoing hip arthroscopy during the study period from April 2008 to April 2013. All patients who had undergone hip arthroscopy with both a LCEA > 400 and profunda acetabulae as defined by the ilioischial line lateral to medial border of the teardrop without a prior history of hip surgery or previous hip conditions were included. This group was matched in a one to one ratio with a control with a LCEA > 250 and =400 according to age within 3 years, sex, body mass index categories, Tonnis grade, labral treatment and capsular treatment. Range of motion, impingement signs, and radiographic indices of coverage and version were recorded in each group. Four patient reported outcome scores (PROs), Visual Analogue Scale (VAS) for pain, patient satisfaction, revision hip arthroscopies and conversion to total hip arthroplasty (THA) were also recorded.
Results: 39 patients met the inclusion criteria for the over coverage/study group of which 36 (92.3%) patients had two-year follow-up. 215 patients satisfied the inclusion criteria for the normal coverage/control group of which 183 (85.1%) had minimum two-year follow-up. 36 patients were matched in each group using the above criteria. There was no difference with respect to range of motion and impingement signs between the groups. The study group had significantly higher radiological markers of over coverage but not retroversion compared to the control group. The study group had a significantly higher incidence of Seldes type 2 tears compared to the control group – 50% vs 19.4%. Both groups demonstrated significant improvements in the mean of all PROs but the study group had a lower magnitude of improvement for all the PROs but the study group had a lower magnitude of improvement for all the PROs with mHHS achieving statistical significance – 13.5 vs 21.7 points. The study group a significantly lower mean patient satisfaction score compared the control - 6.61 versus 7.91. The study group also had a significantly higher conversion rate to THA – 4 versus 0.
Conclusion: Hip arthroscopy in patients with combined over coverage and coxa profunda is associated with improvements in patient outcomes and pain at minimum two-year follow-up. However, the degree of improvement is of lower magnitude compared to matched cohort with normal coverage. While hips with lateral over coverage combined with coxa profunda may have a smaller potential for improvement compared to hips with normal coverage, this type of osseous morphology is still amendable to arthroscopic treatment.