Outcomes may decline after revision hip arthroscopy for borderline dysplasia
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Clinical improvement may still be achieved among patients with borderline hip dysplasia who undergo revision hip arthroscopy despite being less likely to achieve patient-acceptable symptom state metrics for several subjective outcomes, according to published results.
Shane J. Nho, MD, MS, and colleagues compared patient demographics, comorbid medical conditions and preoperative outcome scores for patients with borderline hip dysplasia who had revision hip arthroscopy to those of patients with borderline hip dysplasia undergoing primary arthroscopy and patients without borderline hip dysplasia undergoing revision arthroscopy for femoroacetabular impingement. All patients were matched 2:1 by age and BMI. At 2-year follow-up, researchers used multivariate regressions to compare hip outcome score-activities of daily living and sports subscale scores, as well as modified Harris Hip Scores, for the cohorts. Researchers determined predictors of achieving a minimal clinically important difference and a patient-acceptable symptom state using binomial regression analysis.
Results showed the borderline hip dysplasia revision, borderline hip dysplasia non-revision and non-borderline hip dysplasia revision cohorts had no statistical differences in age and BMI. Although the borderline hip dysplasia revision group had no statistically significant differences in 2-year clinical outcomes compared with either the borderline hip dysplasia primary or non-borderline hip dysplasia revision patient groups, researchers found the patient-acceptable symptom state for the hip outcome score-sports subscale was significantly less likely to be achieved by the borderline hip dysplasia revision group. Despite this poorer trend among patients in with borderline hip dysplasia who underwent revision hip arthroscopy, Nho noted the study was underpowered, and that “patients undergoing revision hip preservation surgery may fail for multiple reasons.”
“This study is a significant addition to the literature regarding revision hip arthroscopy in the setting of [borderline hip dysplasia] BHD. Our results show that there may be diminishing returns with revision hip arthroscopy in this cohort,” Nho told Healio/Orthopedics. “The decision of revision hip arthroscopy is ultimately weighted against [periacetabular osteotomy] PAO or joint replacement. As such, it would be clinically useful for additional studies to compare our results to a similar cohort of patients with BHD undergoing PAO after failed hip arthroscopy.” – by Casey Tingle
Disclosures: Nho reports he receives non-financial support from Allosource, Arthrex Inc., Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, Springer and Stryker; other support from American Journal of Orthopedics, American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; and personal fees from Ossur and Springer. Please see the study for all other authors’ relevant financial disclosures.
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