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Hip Arthroscopy and Borderline Developmental Dysplasia of the Hip: A Systematic Review
Yuichi Kuroda1, Masayoshi Saito1, Karadi Hari Sunil Kumar2
1Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust; Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital.
Insights
Hip arthroscopy effectively treats borderline developmental dysplasia of the hip (BDDH), improving patient outcomes with few complications. Factors like age and femoral anteversion influence results, while female sex is linked to better outcomes.
Area of Science:
- Orthopedic Surgery
- Hip Preservation
- Biomechanical Engineering
Background:
- Borderline developmental dysplasia of the hip (BDDH) presents unique challenges in hip preservation.
- Understanding the efficacy and risks of hip arthroscopy in BDDH is crucial for patient management.
Purpose of the Study:
- To conduct an up-to-date, evidence-based review of hip arthroscopy for patients diagnosed with borderline developmental dysplasia of the hip (BDDH).
Main Methods:
- Systematic literature search of PubMed, EMBASE, and Cochrane Library adhering to PRISMA guidelines.
- Inclusion of all studies involving BDDH, assessing quality with Methodological Index for Non Randomized Studies and Newcastle-Ottawa Scale.
- Analysis of BDDH definition, surgical techniques, labral/cartilage lesions, outcomes, and prognostic factors.
Main Results:
- 28 studies (1502 hips) analyzed, with BDDH typically defined by a lateral center-edge angle of 20°-25°.
- Hip arthroscopy demonstrated significant improvement in modified Harris Hip Score (60.2 to 81.7) and high rates of minimal clinically important difference (79.5%-87%).
- Complication rate was low (1.0%), with cartilage damage noted in 4 studies. Risk factors for poor outcomes included age >35-42 years and femoral anteversion ≥20°.
Conclusions:
- Hip arthroscopy, particularly with capsular plication, offers short-term improvements in patient-reported outcomes for BDDH with a low complication profile.
- BDDH is associated with potential femoral head cartilage damage.
- Positive outcomes are linked to female sex; older age, excessive femoral anteversion, and anterior acetabular undercoverage are associated with poorer results.
Purpose:
To provide an up-to-date evidence-based review of hip arthroscopy for patients with borderline developmental dysplasia of the hip (BDDH).
Methods:
Literature describing hip arthroscopy in patients with BDDH was systematically identified from PubMed, EMBASE, and Cochrane Library using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All studies that involved BDDH and not just those reporting their clinical outcomes were included. Methodological Index for Non Randomized Studies criteria and Newcastle-Ottawa Scale were used to assess the quality of studies. The definition of BDDH, operative technique, correlation with labrum and/or cartilage lesions, outcome, and factors associated with poor outcome were collected and analyzed.
Results:
Assessment of the articles yielded 28 studies involving 1502 hips that were included for final analysis. There were no studies with a high risk of bias. BDDH was defined as lateral center-edge angle of 20° to 25° in most studies. Hip arthroscopy for BDDH showed an improvement in the weighted mean postoperative modified Harris Hip Score, from 60.2 to 81.7, a relatively high rate of acquisition of minimal clinically important difference of 79.5% to 87%, and had 1.0% rate of complications. Eleven studies reported on all the patients undergoing a capsular plication. Four studies reported that BDDH was associated with cartilage damage on the femoral head. Age older than 35 or 42 years and ≥20° of femoral anteversion were reported as risk factors for poor outcomes.
Conclusions:
Hip arthroscopy for BDDH with capsular plication provides improvement in patient-reported outcome measures and a relatively high rate of acquisition of minimal clinically important difference with a low rate of complications in the shorter term. BDDH may be associated with cartilage damage on the femoral head. Female sex is a factor related to good outcomes, whereas older age, excessive femoral anteversion, and anterior undercoverage of acetabulum are risk factors related to poorer outcomes.
Level Of Evidence:
Level IV, systematic review of Level III to IV studies.
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