Management of the Dysplastic Hip: Staged Hip Arthroscopy and Periacetabular Osteotomy
Joel C. Williams, Ty L. Monty, Kristen I. Barton, Chandler A. Sparks, Shane J. NhoBackground:
Hip pathologies, such as femoroacetabular impingement syndrome, labral tear, and developmental dysplasia of the hip, often coexist in patients with chronic hip pain. Hip arthroscopy is the gold standard for intra-articular hip pathology, such as labral tears, while hip dysplasia is corrected with a periacetabular osteotomy (PAO). Concomitant hip arthroscopy and PAO have shown favorable outcomes. Some surgeons have chosen a staged approach for several reasons, including reduced fluid extravasation that disrupts anatomic planes, concern about premature osteotomy failure if PAO is performed first, elimination of the need for table transfer, long operative times when performed concomitantly, facility resources, and individual surgeon comfort/experience.
Indications:
A patient requires intra-articular pathology and a lateral center-edge angle (LCEA) of <25° to be eligible for a combined hip arthroscopy and PAO. Careful consideration is taken when considering the dysplastic patients with borderline hip dysplasia (LCEA <18°-25º), as arthroscopy could further destabilize the joint. Without proper realignment of the acetabulum via PAO, the patient may not receive clinical benefit. Further, frank dysplastic patients (LCEA <18º) should be dissuaded from undergoing hip arthroscopy alone, and a dysplasia evaluation is necessary.
Technique Description:
Hip arthroscopy is used to treat intra-articular pathology, usually as the index procedure. Standard hip arthroscopy proceedings are required. Subsequently, the PAO is performed 7 to 14 days after the hip arthroscopy to correct acetabular malalignment and treat dysplasia. A Bernese PAO approach is utilized in the reported case.
Results:
Findings show that patients improve at short-term follow-up and reach the minimal clinically important difference and the patient-acceptable symptom state at high rates. The improvements seen in the staged procedure are consistent with those in the concomitant procedure at short-term follow-up.
Discussion/Conclusion:
In the short term, both the staged and concomitant procedures improve patient outcomes, with no difference in patient-reported outcomes between the 2 procedures, suggesting that the decision to undergo concomitant versus staged hip arthroscopy and PAO may be a logistical consideration. More long-term comparative data are needed to determine whether the approaches differ.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.