Periacetabular osteotomy for developmental hip dysplasia with labral tears: is arthrotomy or arthroscopy required?

Songkiat Thanacharoenpanich,Robert F Murphy,Michael B Millis,Yi-Meng Yen,Matthew J Boyle,Patricia E Miller,Young-Jo Kim

doi:10.1093/jhps/hnx048

Abstract

ABSTRACTPatients with developmental dysplasia of the hip (DDH) who undergo periacetabular osteotomy (PAO) often have labral tears. The objective of this retrospective study was to compare PAO alone with PAO combined with arthrotomy or arthroscopy in DDH patients who had a full-thickness labral tear on magnetic resonance imaging. In total, 47 hips in the PAO group (PAO) were compared with 60 hips in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) with respect to Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Harris Hip Score (mHHS), Visual Analog Scale (VAS), clinical and radiographic outcomes at a median of 29 months. Reoperation rate and complications were compared between two groups of treatment. The PAO group was younger than the PAO-A group (25.2 ± 9.7 versus 31.3 ± 8.3). The PAO group was more likely to have worse dysplasia: lateral center edge angle (7.6°±9.63° versus 10.8°±6.85°) and anterior center edge angle (4°±12.92° versus 10.8°±9.92°). The PAO group had a higher preoperative mHHS (65.2 ± 15.3 versus 57.8 ± 14.8) and HOOS (66.3 ± 17.5 versus 55.8 ± 20.1). There were no significant differences in final functional outcome scores across treatment groups: mHHS (PAO; 86.8 ± 12.4 versus PAO-A, 83.3 ± 17.2), HOOS (86.5 ± 13.3 versus 82.5 ± 16.8) and VAS (2.5 ± 2.8 versus 2.5 ± 3.1). There was no difference in reoperation rate between two groups (6.4% versus 11.6%, P = 0.51). The overall complication rate was lower in the PAO group (26% versus 68%), but major complications were comparable. On the basis of our data, we were not able to conclusively demonstrate a clear benefit for the routine treatment of all labral tears; however, arthrotomy or arthroscopy may play a role in some conditions.

Highlights

Developmental dysplasia of the hip (DDH) is one of the more common causes of hip osteoarthritis in young adults
heterotopic ossification (HO) occurred after surgery in the periacetabular osteotomy (PAO) group significantly less than in the PAO with concomitant arthrotomy or arthroscopy (PAO-A) group [7 hips (15%) versus 29 hips (48%), P 1⁄4 0.002]. In this retrospective study, we did not find any significant differences in clinical, radiological or functional outcomes between patients that underwent PAO alone and patients that underwent combined PAO and hip arthroscopy or arthrotomy for the treatment of symptomatic developmental dysplasia of the hip (DDH) in the presence of a labral tear found on magnetic resonance imaging (MRI)
Previous authors have reported on the satisfactory outcomes following PAO; the treatment of any labral pathology varies widely within these reports

Summary

Introduction

Developmental dysplasia of the hip (DDH) is one of the more common causes of hip osteoarthritis in young adults. The bony acetabulum in patients with DDH is abnormally shallow, often resulting in labral hypertrophy and forcing the acetabular labrum to play a larger role in weightbearing and joint stability, which may eventually lead to tensile labral failure [1,2,3,4,5]. The weightbearing area of acetabular cartilage is correspondingly reduced resulting in increased cartilage contact forces which can lead to progressive articular cartilage damage. The Bernese periacetabular osteotomy (PAO) is an effective surgical treatment for symptomatic DDH that reorients the dysplastic acetabulum resulting in improved hip stability, femoral head coverage and joint biomechanics [6,7,8,9]. Labral pathology is common in patients with DDH, with labral tears reported in 60–100% of patients undergoing

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Conclusion