Outcomes of joint preservation surgery: comparison of patients with developmental dysplasia of the hip and femoroacetabular impingement.

Etienne L Belzile,Jae-Jin Ryu,John C Clohisy,Paul E Beaulé

doi:10.1093/jhps/hnw033

Abstract

Femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH) are fundamentally and structurally different hip abnormalities yet their clinical presentation can often be very similar. We asked whether adult patients surgically treated for DDH when compared with FAI patients achieve (i) better outcome as reflected by the WOMAC Osteoarthritis Index, (ii) higher physical activity as reflected by the UCLA physical activity scale. Five hundred fifty-six patients treated by periacetabular osteotomy for DDH and 540 patients treated for FAI (cam, pincer, or combined) in nine high-volume centers, between 2008 and 2011 were matched using propensity analysis, based on age and BMI. After exclusions, 144 pairs were evaluated on WOMAC, SF-12 Health Survey, modified Harris Hip Score (mHHS) and UCLA scale at pre and post-operations. At pre-operative evaluation, FAI patients showed lower scores on WOMAC (total, stiffness, function) and SF-12 physical. Statistically significant improvements in the outcome scores were observed from pre to post-operative time points in both treatment groups. Once FAI and DDH patients were compared, FAI patients showed lower scores on most of the outcome measures. However, these differences diminished in time, with only SF-12 mental and mHHS scores remaining significantly lower at 2-year follow-up. Because of more advanced disease at presentation, patients with FAI had an inferior clinical outcome compared with patients with DDH after surgical correction. Further prospective studies are required to better describe the long-term clinical benefits of hip joint preservation surgery.

Highlights

With the advent of advanced three-dimensional imaging as well as less invasive surgical techniques such as hip arthroscopy, hip preservation surgery has grown in knowledge and in number of advocates over the last decade [1, 2]
We have compared two matched cohorts of femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH) patients treated in high-volume centers and have demonstrated that both groups show significant improvements in post-operative functional outcomes
The functional scores of DDH patients were higher at baseline and 1-year post-operation, this difference is substantially diminished at the 2-year follow-up

Summary

INTRODUCTION

With the advent of advanced three-dimensional imaging as well as less invasive surgical techniques such as hip arthroscopy, hip preservation surgery has grown in knowledge and in number of advocates over the last decade [1, 2]. Open and arthroscopic treatments of FAI-related pathologies (i.e. chondroosteoplasty) for cam correction and reverse PAO for acetabular retroversion have proven to provide consistent early QOL improvements [13, 14] For both conditions, the quality of the cartilage and patient age at presentation, have a significant impact on the clinical outcome of these surgical interventions [15, 16]. FAI patients tend to have stiffer joints and limited hip range of motion in internal rotation It is unclear if these leading causes of intra-articular hip damage respond to surgical correction and if not should they be approached differently in regards to diagnosis and management.

Surgical procedures

RESULTS

DISCUSSION