Rapidly Progressive Osteoarthritis after Arthroscopic Labral Repair for Dysplasia. Dean K. Matsuda, MD Monti Khatod, MD Los Angeles, California, USA
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1 Rapidly Progressive Osteoarthritis after Arthroscopic Labral Repair for Dysplasia Dean K. Matsuda, MD Monti Khatod, MD Los Angeles, California, USA
2 Recent reports of poor clinical outcomes after arthroscopic surgery in hips with marked dysplasia have emerged. Arthroscopic resection of the hypertrophic labrum of dysplasia, especially in the absence of periacetabular osteotomy (PAO), has been implicated. As a major open procedure, some patients will refuse PAO, opting for a less invasive arthroscopic procedure. We present 2 young adult patients with marked dysplasia, who suffered rapidly progressive osteoarthrosis despite arthroscopic labral repair. Introduction
3 Case 1 29 yo woman with CEA 10 degrees refused offered PAO and underwent arthroscopic labral repair plus cam decompression and progressed to rapidly progressive osteoarthritis within 7 months
4 Case 2 31 yo woman with CEA 11 degrees opted for arthroscopic labral repair over PAO with rapidly progressive osteoarthritis requiring total hip arthroplasty within 12 months
5 Although perhaps beneficial as an isolated procedure in borderline or mild dysplasia, arthroscopic hip surgery, even labral repair, may best be performed with PAO in more severe dysplasia. Albeit attractive as a less invasive labral preserving surgery, arthroscopic labral repair may not only fail to provide symptomatic improvement, but may compromise or preclude a later PAO if rapidly progressive osteoarthrosis ensues. Hip arthroscopy may best be performed concurrently or following but not proceeding PAO in patients requiring the both procedures. Conclusions
6 Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy Dec;19(10): McCarthy JC, Lee J. Hip Arthroscopy: Indications, Outcomes, and Complications. The Journal of Bone & Joint Surgery. 2005; 87: Parvizi J, Bican O, Bender B, Mortazavi SM, Purtill JJ, Erickson J, Peters C. Arthroscopy for labral tears in patients with developmental dysplasia of the hip: a cautionary note. J Arthroplasty Sep;24(6 Suppl): Benali Y, Katthagen BD. Hip subluxation as a complication of arthroscopic debridement. Arthroscopy Apr;25(4): Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: Can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy 28(3), Mar 2012: p Paliobeis CP, Villar RN. The prevalence of dysplasia in femoroacetabular impingement. Hip Int Apr 11;21(2): Ross JR, Zaltz I, Nepple JJ, Schoenecker PL, Clohisy JC. Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med Jul;39 Suppl:72S-8S. Troelsen A. Assessment of adult hip dysplasia and the outcome of surgical treatment. Dan Med J Jun;59(6):B4450. Ito H, Tanino H, Yamanaka Y, Minami A, Matsuno T. Intermediate to long-term results of periacetabular osteotomy in patients younger and older than forty years of age. J Bone Joint Surg Am Jul 20;93(14): Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res Aug;467(8): J Bone Joint Surg Am Mar;93 Suppl 1:30-9. Troelsen A, Elmengaard B, Søballe K. Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am Sep;91(9): Matheney T, Kim YJ, Zurakowski D, Matero C, Millis M. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome. J Bone Joint Surg Br Jul;91(7): Lian Y, Lian X, Lu D, Zhou Y, Wang K, Liu Q, Zhou Z. Treatment of adult developmental dysplasia of the hip by rotational acetabular osteotomy combined with debridement under arthroscope. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Jul;25(7): Kim KI, Cho YJ, Ramteke AA, Yoo MC. Peri-acetabular rotational osteotomy with concomitant hip arthroscopy for treatment of hip dysplasia. J Bone Joint Surg Br Jun;93(6): Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol Jun;188(6): Fujii M, Nakashima Y, Yamamoto T, Mawatari T, Motomura G, Matsushita A, et al. Acetabular retroversion in developmental dysplasia of the hip. J Bone Joint Surg Am Apr;92(4): Nehme A, Trousdale R, Tannous Z, Maalouf G, Puget J, Telmont N. Developmental dysplasia of the hip: is acetabular retroversion a crucial factor? Orthop Traumatol Surg Res Nov;95(7): References
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