ePoster #1502 - ISHA Annual Scientific Meeting 2016

Arthroscopic Treatment of Hip Pain in Adolescent Patients with Borderline Dysplasia of the Hip: Minimum Two Year Follow-Up

Peter T Evans, BS, Westmont, IL UNITED STATES
John M. Redmond, MD, Westmont, IL UNITED STATES
Jon E. Hammarstedt, BS, Westmont, IL UNITED STATES
Yuan Liu, BS, Westmont, IL UNITED STATES
Edwin Chaharbakhshi, BS, Hinsdale, IL UNITED STATES
Benjamin G. Domb, MD, Chicago, IL UNITED STATES

American Hip Institute, Westmont, IL, UNITED STATES

FDA Status Not Applicable

Summary: This study demonstrates improved PRO outcomes in patients less than 18 years old with radiographic evidence of borderline dysplasia similar to a matched group without dysplasia; hip arthroscopy, including capsular plication, for the treatment of hip pain in an adolescent population with borderline dysplasia has satisfactory outcomes.

Abstract:
Background: Arthroscopic labral treatment and capsular plication for borderline hip dysplasia has been described with favorable outcomes. Currently, there is paucity of literature detailing the outcomes of its use in the adolescent population. Purpose: To examine the arthroscopic treatment of hip pain in patients with borderline hip dysplasia (lateral center-edge angle (LCEA)- - 20º = x < 25º). Methods: From 2008 to 2013, data were collected prospectively on all patients under 18 years of age that underwent arthroscopic hip surgery and retrospectively reviewed. Patients with previous hip surgery, acetabuloplasty, previous hip conditions, and capsular repair or release were excluded, as were those without labral treatment. Patients with a LCEA 20º = x < 25º were matched at a 1:1 ratio to a control group of patients without dysplasia (LCEA =25º). The patients were matched according to age under 18 years old, gender, femoroplasty, labral treatment and capsular treatment. Indications for surgery included failure to improve with non-operative treatments (minimum 3 months) including physical therapy and anti-inflammatory medications. Patient reported outcome (PRO) data was prospectively collected pre- and post-operatively using five tools: modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADLS), Sports Specific Subscale (HOS-SSS), Non Arthritic Hip Score (NAHS), and Visual Analog Scale (VAS). Revisions were recorded. Results: From 2008 to 2013, 168 patients under the age of 18 underwent arthroscopic hip surgery. A total of 21 of patients met the inclusion criteria and were matched 1:1 to a control group. Follow-up was achieved for 17 patients in both groups (81%) and the mean follow-up time was 2.19 years (median=2.83 years) for the dysplastic group and was 2.16 years for the control group (median=2.67 years). The mean age was 15.5 years (median age=15.7) in the borderline dysplastic group; the control group mean and median age was 16.0 years. . The mean pre-operative LCEA was 22.3° for the mildly dysplastic group and was 31.2° for the control group (P <0.0001). The preoperative PRO measurements between groups were not statistically different. At latest follow-up, all PROs for both groups (mHHS, HOL-ADL, HOL-SSS, NAHS) showed statistically significant improvement from their preoperative baseline (P <0.0001), as did VAS (P <0.0001). There were no statistical differences in postoperative PRO scores between the two groups at latest follow-up (mHHS, P=0.49; HOL-ADL, P=0.82; HOL-SSS, P=0.27; NAHS, P=0.45; VAS, P=0.41; Satisfaction, P=0.54). No patients in either group required revision. Conclusions: This study demonstrates improved PRO outcomes in patients less than 18 years old with radiographic evidence of borderline dysplasia. The improvement appears to be similar to a matched group without dysplasia. Hip arthroscopy, including capsular plication, for the treatment of hip pain in an adolescent population with borderline dysplasia has satisfactory outcomes when physical therapy has not provided symptomatic relief.