2015 ISAKOS Biennial Congress ePoster #805
Combined Hip Arthroscopy and Peri-Acetabular Osteotomy: Intra-Articular Pathology
Raymond J. Kenney, MD, Rochester, NY UNITED STATES
Christopher Cook, MD, Rochester, NY UNITED STATES
Kelly McMullen, MEd, ATC, Rochester, NY UNITED STATES
Brian Giordano, MD, Rochester, NY UNITED STATES
University of Rochester, Rochester, NY, USA
FDA Status Not Applicable
Summary: The purpose of this study was to delineate the types and rate of intra-articular pathology in patients who have undergone combined hip arthroscopy and PAO at a high volume hip preservation center.
Uncorrected symptomatic acetabular dysplasia may increase the risk of functional impairment and degenerative joint disease. Previous studies have linked acetabular dysplasia to premature osteoarthritis and an increased likelihood of requiring arthroplasty. In the presence of acetabular dysplasia, there is insufficient containment of the femoral head, leading to focal articular overload. An increased sheer vector places strain on the acetabular rim and may encourage hypertrophic development of the labrum, as a compensatory mechanism to improve congruity of the femoral head within the acetabulum. The resulting hypertrophic labrum commonly fails, and may contribute to hip pain and pelvic dysfunction. Intra-articular pathology has been reported for both arthroscopic and open hip preservation surgery, but to date, there have been few publications that have reported data for combined hip preservation surgery. The purpose of this study was to delineate the types and rate of intra-articular pathology in patients who have undergone combined hip arthroscopy and PAO at a high volume hip preservation center. Methods: A retrospective review was conducted to determine types and rate of intra-articular pathology for 29 consecutive patients with 33 surgically treated hips who underwent combined hip arthroscopy and PAO from June 2012 through October 2013. Charts were reviewed for arthroscopy operative notes noting intra-articular pathology at the time of the combined procedure. Results: 29 consecutive patients with 33 surgically treated hips (Average age 30 at time of surgery; Range 13-55) were reviewed. Chondromalacia of the acetabulum was documented in all 33 hips (100%) most commonly in geographic zones 2 and 3. 22 hips (67%) had chondromalacia in more than one zone of the acetabulum. Labral pathology was noted in 31 patients (94%), most commonly documented pathologies were labral hypertrophy (16 patients, 48%) and frank labral-chondral disruption at the transitional zone (26 patients, 79%). There was evidence of maceration and fraying of the labrum (4 patients, 12%), prior labral repair (2 patients, 6%), labral deficiency, and labral bruising (1 patient each, 3%). Ligamentum teres pathology was documented in 25 patients (76%). Partial thickness tear was most common (21 patients, 64%). Ligamentum teres hypertrophy (3 patients, 9%) and complete tear (1 patient, 3%) were also documented. Concomitant femoral acetabular impingement (FAI) morphology was documented in 30 patients (91%). Mixed FAI was most common (21 patients, 64%), isolated cam (8 patients each, 24%) and focal pincer type acetabular rim prominence (1 patient, 3%) FAI less commonly documented. Synovitis was documented in 28 patients (85%) and loose bodies were documented and removed in 15 patients (45%). Loose bodies largely represented chondral fragments, focal labral calcifications, or acetabular rim fractures. Conclusion: In a series of patients with acetabular dysplasia undergoing combined hip arthroscopy and PAO, a high rate of coexistent intra-articular pathology was encountered. This corresponds more favorably with recent knowledge, gained from arthroscopic inspection and treatment of intra-articular joint structures. Traditional arthrotomy may offer a more limited window into the central compartment, and subsequently fail to address all potentially treatable intra-articular pathology.