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Hip arthroscopy may improve excessive femoral anteversion, borderline dysplasia
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Despite significant improvements in patients with combined excessive femoral anteversion and borderline dysplasia when treated with arthroscopic labral preservation and capsular closure, these results were significantly inferior when compared with a matched control group, according to a recently published study.
Of the 16 patients with combined excessive femoral anteversion and borderline dysplasia (EFABD) undergoing arthroscopic labral preservation and capsular closure, researchers matched 12 patients to 24 patients with normal coverage and femoral anteversion by age at surgery, sex, BMI, acetabular Outerbridge grade and iliopsoas fractional lengthening. Within 1 month prior to surgery, all patients completed preoperative questionnaires to establish baseline modified Harris Hip Scores, nonarthritic hip score, hip outcome score–sports specific subscale and VAS. Researchers collected follow-up scores and patient satisfaction beginning 3 months postoperatively and at each annual follow-up.
Results showed patients in the EFABD group had a mean femoral version of 22.4° and a mean lateral center-edge angle of 22.1° compared with 10.2° and 31.5° in the control group, respectively. Researchers wrote that patients in the control group underwent acetabuloplasty “significantly more frequently” than the comparison group. However, researchers found no other significant differences regarding demographics, findings, procedures or preoperative scores.
Patients in the EFABD group had significantly lower mean modified Harris Hip Score, nonarthritic hip score, hip outcome score–sports specific subscale and patient satisfaction at latest follow-up, according to results. Researchers found 33.3% of patients in the EFABD group underwent a secondary surgical procedure vs. 4.2% of patients in the control group. Results showed arthroplasty was required for one patient in each group. – by Casey Tingle
Disclosure s : Chaharbakhshi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Aaron J. Krych, MD
“Mild” or “borderline” dysplasia represents a spectrum of pathology. While it is important to define dysplasia by acetabular undercoverage, it is imperative to recognize that deformities on the femoral side, such as coxa valga or increased femoral anteversion, can play a significant role. Surgical options for treating the symptomatic hip with mild dysplasia historically include proximal femoral osteotomy and acetabular osteotomy. More recently, hip arthroscopy has become popular. When choosing these treatment options, appropriate patient selection is paramount. The current study by Chaharbakhshi and colleagues highlights the role of excessive femoral anteversion in decision-making. The authors demonstrate improvements in pain and function after arthroscopic labral repair and capsular plication in mild dysplasia and increased femoral anteversion.
However, when compared to well-matched patients with femoroacetabular impingement, the outcomes were inferior. This is likely explained by the combination of lateral acetabular undercoverage and increased femoral anteversion producing significant instability and cartilage overload that may not be adequately addressed with arthroscopic treatment alone. In this setting, bony procedures, such as periacetabular or femoral osteotomy, may be indicated.
Going forward, there is a critical need to better anatomically define the spectrum of “mild hip dysplasia” and indications for the optimal surgery in this patient population.
Mayo Clinic
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