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Lee SH, Alarcon Perico D, Hevesi M, Sierra RJ. A New Arthroscopic Classification for Chondrolabral Disease in Patients Undergoing Surgery for Developmental Dysplasia of the Hip. Am J Sports Med 2024; 52:643-652. [PMID: 38279831 DOI: 10.1177/03635465231221507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
BACKGROUND Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia. PURPOSE To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 46 hips underwent combined hip arthroscopy and PAO at our institution between September 2013 and December 2014, irrespective of symptoms or radiographic findings. PROMs were evaluated preoperatively and at 2 years postoperatively. At the time of hip arthroscopy, the chondrolabral junction was classified as normal without tear (1 hip, type 1); hypertrophic labrum without chondrolabral disruption (19 hips, type 2); chondrolabral disruption on the articular side, not extending into the capsular side (16 hips, type 3A); chondrolabral disruption extending through the capsular side (3 hips, type 3B); and exposed acetabular subchondral bone (7 hips, type 4). RESULTS There was a significant difference in postoperative modified Harris Hip Score (mHHS) (P = .020), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (P = .037), and WOMAC total scores (P = .049) between chondrolabral junction types. Post hoc analyses demonstrated significant differences between type 2 (84.9 ± 12.9) and type 3A (67.8 ± 20.7; P = .198), and between type 2 and type 4 (59.3 ± 24.3; P = .011) in postoperative mHHS scores; and between type 2 (83.9 ± 12.9) and type 3A (68.9 ± 23.7; P = .045) in postoperative WOMAC total scores. In multivariate analysis, chondrolabral type 3 or type 4, age >35 years, and previous surgery were significantly correlated with worse mHHS scores at 2 years. CONCLUSION This new chondrolabral classification is proposed to describe intra-articular pathology seen during combined hip arthroscopy and PAO, specifically in dysplastic hips. More advanced chondrolabral disease was associated with worse PROMs at 2 years.
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Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Flemig AJD, Selley RS, Essilfie A, Robustelli S, Schneider BL, Ranawat A, Nawabi D, Kelly BT, Sink EL. The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy. Am J Sports Med 2023; 51:1217-1223. [PMID: 36927195 DOI: 10.1177/03635465231156189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND It is currently unknown whether the addition of arthroscopic labral repair in the setting of periacetabular osteotomy (PAO) provides any clinical benefit. PURPOSE/HYPOTHESIS The purpose of this study was to compare outcomes of patients who underwent arthroscopic labral repair concomitantly with PAO versus patients who underwent PAO alone. We hypothesized that there would be no difference in patient-reported outcome measures (PROMs) between the cohorts. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing PAO from a single-center prospective hip preservation registry were eligible for this study if they completed pre- and postoperative PROMs (minimum, 1 year). PROMs were collected at 1 year, 2 years, and latest follow-up at 6.05 years for PAO group and 4.2 years for scope/PAO group. The study group consisted of 53 patients who underwent arthroscopic labral repair at the time of their PAO, and the comparison group consisted of 170 patients who underwent PAO alone. A subset of the PAO group who had radiologic evidence of a detached labral tear (n = 33) was also compared with the rest of the PAO-alone group. PROMs were compared at every time point for both groups as well as the subset of patients who underwent PAO alone despite a labral tear. RESULTS The mean follow-up of all patients was 2 years (range, 1-6 years). Overall, 85.2% of the PAO group and 85.7% of the scope/PAO group met the minimal clinically important difference for either the modified Harris Hip Score (mHHS) or the International Hip Outcome Tool (iHOT-33) at the most recent follow-up. There was no difference in improvement between groups (mHHS, P = .670; iHOT-33, P = .944). Patients who had a radiologically diagnosed detached labral tear and underwent PAO alone had no difference in outcomes when compared with the rest of the PAO cohort (mHHS, P = .981; iHOT-33, P = .909). CONCLUSION There was no significant benefit measured by PROMs at follow-up for concomitant arthroscopic labral repair in the setting of PAO.
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Affiliation(s)
| | - Ryan S Selley
- Northwestern Memorial Hospital, Chicago, Illinios, USA
| | | | | | | | - Anil Ranawat
- Hospital for Special Surgery, New York, New York, USA
| | - Danyal Nawabi
- Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Hospital for Special Surgery, New York, New York, USA
| | - Ernest L Sink
- Hospital for Special Surgery, New York, New York, USA
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Goronzy J, Günther KP. [Hip dysplasia: What influence do age, arthrosis and concomitant diseases have on the treatment result?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:282-292. [PMID: 36894594 DOI: 10.1007/s00132-023-04354-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/11/2023]
Abstract
Pelvic osteotomies are an established treatment for symptomatic adult hip dysplasia with a promising long-term outcome. Results depend not only on the achieved acetabular reorientation but also on patient-factors like preoperative joint condition (degree of osteoarthritis and joint congruency) and age. Additionally, the diagnosis and appropriate therapy of impingement-associated hip deformities is essential in order to achieve good mid- and long-term outcomes. The influence of chondrolabral pathology on the outcome of pelvic osteotomies is not yet defined. Symptomatic patients with residual dysplasia after previous pelvic or acetabular osteotomies can benefit from an additional osteotomy, although results can be worse in comparison to prior unoperated joints. Obesity can make surgery more demanding and increases the complication profile of PAO, although it has no influence on the postoperative outcome. Regarding the overall prognosis after an osteotomy, the consideration of combined risk factors is superior to the concentration on individual factors alone.
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Affiliation(s)
- Jens Goronzy
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Lara J, Garín A, Herrera C, Abara S, Besomi J, Villegas D, Neumann H, Tobar C. Bernese periacetabular osteotomy: functional outcomes in patients with untreated intra-articular lesions. J Hip Preserv Surg 2020; 7:256-261. [PMID: 33163210 PMCID: PMC7605770 DOI: 10.1093/jhps/hnaa014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) has been recognized to be a condition leading to osteoarthritis. Periacetabular osteotomy (PAO) has showed good results on hip preservation treatment for these cases. Nevertheless, intra-articular damage may be responsible for persistent post-operative symptoms, so treat the articular damage before or during the PAO has emerged as an alternative to address it. The objective is to identify the prevalence of intra-articular damage, functional outcomes of patients undergoing PAO with untreated intra-articular lesions and the survivorship free total hip arthroplasty (THA) at long-term follow-up. A retrospective review of 103 hips in 92 patients, mean age 26 years old (19–31), 96% females. Mean follow-up 7 years (range: 3–16). Intra-articular damage was evaluated with high-resolution magnetic resonance imaging (MRI) previous to perform the PAO, the chondral damage was evaluated using International Cartilage Repair Society classification. Harris Hip Score (HHS) was obtained in all patients. One hundred per cent of the cases had labral tears on MRI, hypertrophic labrum in 80.8% and paralabral cysts in 20.8%. Acetabular chondral damage was Grade 2 in 88.5% of the hips. HHS was good and excellent in 94%. Survivorship free of THA at 15 years was 87%. Chondrolabral damage is a common finding in patients with DDH. Despite that, excellent results are obtained with PAO without labral repair. We think the focus should be in the biomechanical and anatomical correction of the hip in patients with DDH.
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Affiliation(s)
- Joaquín Lara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Alan Garín
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Cristhián Herrera
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Selim Abara
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Javier Besomi
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Diego Villegas
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Hassan Neumann
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
| | - Carlos Tobar
- Orthopaedic Surgery Department, Facultad de Medicina, Hip Center, Clínica Las Condes, Universidad de Chile, Santiago, Chile
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Ibrahim MM, Poitras S, Bunting AC, Sandoval E, Beaulé PE. Does acetabular coverage influence the clinical outcome of arthroscopically treated cam-type femoroacetabular impingement (FAI)? Bone Joint J 2018; 100-B:831-838. [PMID: 29954207 DOI: 10.1302/0301-620x.100b7.bjj-2017-1340.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI. Patients and Methods Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS). Results At a mean follow-up of 2.7 years (1 to 8, sd 1.6), all functional outcome scores significantly improved overall. Radiographically, only preoperative anterior coverage had a negative correlation with the improvement of the HOOS symptom subscale (r = -0.28, p = 0.005). No significant difference in relative change in HOOS subscale scores was found according to the presence or absence of radiographic signs of retroversion. Discussion Our study demonstrated the anterior coverage as an important modifier influencing the functional outcome of arthroscopically treated cam-type FAI. Cite this article: Bone Joint J 2018;100-B:831-8.
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Affiliation(s)
- M M Ibrahim
- Arthroplasty and Adult Reconstruction, Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa, Ottawa, Ontario, Canada and Lecturer of Orthopaedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - S Poitras
- Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - A C Bunting
- Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa
| | - E Sandoval
- Arthroplasty and Adult Reconstruction, Division of Orthopaedic Surgery, The Ottawa Hospital/l'Hôpital d'Ottawa,, Ottawa, Ontario, Canada and Alai Sports Medicine Clinic, Madrid, Spain
| | - P E Beaulé
- University of Ottawa, Ottawa, Ontario, Canada and The Ottawa Hospital/l'Hôpital d'Ottawa, Ottawa, Ontario, Canada
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Witt JD, Haddad FS. Acetabular dysplasia: multiple pathologies and myriad solutions. Bone Joint J 2018; 99-B:705-707. [PMID: 28566387 DOI: 10.1302/0301-620x.99b6.bjj-2017-0491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 11/05/2022]
Affiliation(s)
- J D Witt
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London, WC2N 6ET and NIHR University College London Hospitals Biomedical Research Centre, UK
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Malviya A. What the papers say. J Hip Preserv Surg 2016; 3:240-2. [PMID: 27583166 PMCID: PMC5005064 DOI: 10.1093/jhps/hnw028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, NE63 9JJ
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