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Favorable results seen with arthroscopic treatment of FAI with borderline dysplasia
Researchers caution treating symptomatic dysplasia with instability as the chief complaint.
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Investigators of a recently presented study found promising early outcomes in patients treated with arthroscopic labral preservation and capsular closure for femoroacetabular impingement with borderline dysplasia.
“Our results indicate that when treating a patient arthroscopically for symptomatic [femoroacetabular impingement] FAI with borderline dysplasia, favorable outcomes can be expected when a careful approach is adopted, including labral repair and a complete capsular closure,” Danyal H. Nawabi, MD, said during his presentation. “These outcomes are similar to non-dysplastic patients undergoing hip arthroscopy for FAI at a mean of 33 months follow-up.”
In an interview with Orthopedics Today, he added, “Although we have demonstrated favorable outcomes for hip arthroscopy in a group of patients with dysplasia, a high degree of caution must be maintained when counseling a patient for hip arthroscopy in the setting of dysplasia. This operation is only offered to patients with borderline dysplasia who have a predominant symptomatology consistent with FAI and not hip instability. During the arthroscopy, in addition to a well-performed femoral osteochondroplasty, we feel labral preservation and a well-executed complete capsular closure is critical.”
Using a hip registry of nearly 4,000 patients, Nawabi and his colleagues identified 46 patients with borderline hip dysplasia and 131 controls with non-dysplastic hips. The investigators obtained morphologic characteristics of the hips and noted any intraoperative interventions that were performed. In addition, they reviewed patient-reported outcomes noted preoperatively and at 6 months, 1 year, 2 years and 3 years postoperatively.
Results showed the borderline group had a mean lateral center edge angle of 22° and a mean alpha angle of 66°. The control group had a mean lateral center edge angle of 31° and a mean alpha angle of 61°. Nawabi noted all patients underwent capsular closure, and 70% of patients had a labral repair.
“At a mean follow-up of 33 months, statistically significant improvements were obtained in all outcome scores in both groups and, when adjusting for age, sex, alpha angle and preoperative score, there was no difference in the clinical improvement [between] the two groups,” Nawabi said.
Nawabi noted female gender did not appear to be a predictor of inferior outcome. When it came to revision procedures, Nawabi and his colleagues found two patients in the dysplastic group and six patients in the control group required revision arthroscopy.
“We plan to continue following up this cohort of patients longitudinally to determine the durability of the arthroscopic interventions and specifically report whether any of these patients required a [periacetabular osteotomy] PAO for ongoing symptoms or total hip arthroplasty for arthritis. Despite these encouraging results, we recommend caution in treating dysplastic hips with arthroscopy, especially when instability is the chief complaint,” Nawabi told Orthopedics Today. – by Casey Tingle
- Reference:
- Nawabi DH, et al. Paper #26. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 9-12, 2015; Orlando, Fla.
- For more information:
- Danyal H. Nawabi, MD, can be reached at Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021; email: nawabid@hss.edu.
Disclosure: Nawabi reports no relevant financial disclosures.