Hip dysplasia in athletes may not affect outcomes of arthroscopy for impingement
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Key takeaways:
- Hip arthroscopy yielded similar outcomes for flexibility sport athletes with vs. without dysplasia.
- Flexibility sports included dance, gymnastics, cheerleading, figure skating, yoga and martial arts.
According to published results, hip arthroscopy for femoroacetabular impingement yielded similar 2-year outcomes for flexibility sport athletes with vs. without borderline hip dysplasia.
Researchers at Rush University Medical Center performed a retrospective, matched cohort study of data from 257 athletes who participated in a flexibility sport and underwent primary hip arthroscopy for femoroacetabular impingement (FAI) between 2012 and 2020 with minimum 2-year follow-up. According to the study, flexibility sports included dance, gymnastics, cheerleading, figure skating, yoga and martial arts.
Researchers compared patient-reported outcomes (PROs) between 52 athletes (mean age, 26.4 years) who had borderline hip dysplasia, defined by a lateral center-edge angle of 18° to 25°, and 104 propensity score-matched athletes (mean age, 26.3 years) who did not have hip dysplasia.
Researchers noted significant differences in two preoperative imaging measurements between the cohorts. Patients with dysplasia had a lateral center-edge angle of 22.2° and a Tönnis angle of 10.9°, while patients without dysplasia had lateral center-edge angle of 31.5° and a Tönnis angle of 5.8°.
At mean 2-year follow-up, both cohorts achieved significant improvements in all PROs with no significant differences in postoperative PROs between the cohorts. Researchers found 95.7% of patients with dysplasia and 94.8% of patients without dysplasia achieved the minimal clinically important difference. Similarly, 71.7% of patients with dysplasia and 72.2% of patients without dysplasia achieved a patient-acceptable symptom state. Researchers noted no differences between these rates.
Researchers concluded flexibility sport athletes with hip dysplasia should expect similar outcomes after arthroscopy for FAI compared with athletes without hip dysplasia. However, they noted most athletes competed at a recreational level, and it is possible that “differences may be found when comparing athletes that participate at a higher level of competition,” researchers wrote in the study.
Perspective
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This article’s findings are in line with my personal observations, and I commend the authors for this work. The two challenging populations included are the hyperflexible athlete and borderline dysplastic hip. My prior study looking at the dancer’s hip/hyperflexible athletes showed a similar level of improvement in the same patient-related outcome measures at mean 3-year follow-up with an arthroscopic technique. With appropriate management of the capsule, labrum and subtle FAI, this patient population can do well after an arthroscopy.
The borderline dysplastic element of this study adds the further challenge of some osseous instability in addition to soft tissue instability. My experience with these mildly dysplastic hips is that arthroscopy is often successful in an athletic population, whereas periacetabular osteotomies (PAO) might be more appropriate in the setting of higher levels of disability. In addition, performing a PAO in the hyperflexible athlete risks losing hip range of motion, which could be detrimental in this population.
In the end, this is a challenging combination of soft tissue and osseous instability in the setting of athletic activity that pushes the hip joint to the extreme. Surgeons should be extremely thoughtful with appropriate expectations in this patient population.
Reference:
Larson CM, et al. Arthroscopy. 2020;doi:10.1016/j.arthro.2019.09.023.
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