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Hip Arthroscopic Surgery in Borderline Developmental Dysplastic Hips: A Systematic Review

Zheci Ding¹, Yaying Sun¹, Shaohua Liu¹

¹Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.

The American Journal of Sports Medicine

|November 28, 2018

Insights

Hip arthroscopic surgery shows promise for borderline developmental dysplastic hip (BDDH) patients, improving hip function scores. However, outcomes can be affected by various factors, necessitating further research.

Area of Science:

Orthopedic Surgery
Hip Preservation
Minimally Invasive Procedures

Background:

The efficacy of hip arthroscopic surgery in patients with borderline developmental dysplastic hip (BDDH) remains a subject of debate.
BDDH presents unique challenges for surgical intervention due to subtle acetabular dysplasia.

Purpose of the Study:

To systematically review the outcomes of hip arthroscopic surgery in patients diagnosed with BDDH.
To identify factors that may influence the success of these procedures.

Main Methods:

A systematic review of studies published up to March 2018 was conducted using PubMed, Embase, and Cochrane Library.
Included studies focused on primary hip arthroscopic surgery in BDDH patients, assessing patient-reported outcomes and follow-up duration.
The modified Harris Hip Score (mHHS) was the primary outcome measure, with failure rates and other PROMs as secondary outcomes.

Main Results:

Nine studies involving 425 patients demonstrated significant improvements in mHHS (61.8 to 82.8) and most other patient-reported outcomes.
The overall failure rate was 14.1%, with a 8.5% reoperation rate and a 4.4%-26.0% conversion rate to total hip arthroplasty.
Factors such as cartilage damage, osteoarthritis, ligamentum teres tears, and femoroacetabular impingement were found to impact surgical outcomes.

Conclusions:

Hip arthroscopic surgery appears to be a viable option for BDDH, offering potential functional improvements.
However, outcomes are influenced by several risk factors, highlighting the need for careful patient selection.
Higher levels of evidence are required to definitively support these findings and guide clinical practice.

Read full analysis

Abstract

Background:

It remains controversial whether hip arthroscopic surgery should be applied to patients with a borderline developmental dysplastic hip (BDDH).

Purpose:

To review the outcomes of hip arthroscopic surgery for a BDDH and which factors influence these outcomes.

Study Design:

Systematic review.

Methods:

PubMed, Embase, and the Cochrane Library were searched through March 2018 for studies reporting the outcomes of primary hip arthroscopic surgery in patients with a BDDH. Inclusion in the review was based on the definition of a BDDH, patient-reported outcomes, and duration of follow-up. The primary outcome was the modified Harris Hip Score (mHHS). The failure rate, visual analog scale, satisfaction score, and patient-reported outcomes such as the Hip disability and Osteoarthritis Outcome Score were defined as secondary outcomes.

Results:

Nine studies with 425 patients who underwent hip arthroscopic surgery were included in this review. The mean follow-up times ranged from 25.4 to 28.8 months across the studies. A significant improvement was obtained in the mHHS, with a mean score of 61.8 preoperatively to 82.8 postoperatively; all other patient-reported outcomes also improved significantly, except the 12-Item Short Form Health Survey mental component summary. The overall failure rate was 14.1%, and the mean reoperation rate was 8.5%. The rate of conversion to total hip arthroplasty ranged from 4.4% to 26.0%, and the rate of conversion to periacetabular osteotomy was 4.0%. Combined defects such as cartilage damage, hip osteoarthritis, ligamentum teres tears, and femoroacetabular impingement could influence the outcomes after arthroscopic surgery in BDDHs.

Conclusion:

Hip arthroscopic surgery was demonstrated to be a promising approach for BDDHs, but the outcomes could be influenced by multiple risk factors. A higher level of evidence is still needed to support current findings.

Keywords:

borderline developmental dysplasia hip arthroscopic surgery systematic review

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