Combined Hip Arthroscopy and Periacetabular Osteotomy: Intra-Articular Pathology
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1 Combined Hip Arthroscopy and Periacetabular Osteotomy: Intra-Articular Pathology URMC Sports Medicine and Hip Preservation Raymond J. Kenney, MD Kelly L. Adler, MEd, ATC P. Christopher Cook, MD Brian D. Giordano, MD
2 Financial Disclosures: Raymond J. Kenney, MD No financial relationships to disclose Kelly L. Adler, MEd, ATC No financial relationships to disclose P. Christopher Cook, MD Arthrex, Inc: Paid consultant Brian D. Giordano, MD Arthrex, Inc: Royalties; Paid consultant; Paid presenter or speaker; Research support 2
3 Background Patient reported outcomes, complications and intra-articular pathology have been reported in small series of patients who have undergone hip preservation surgery Various types of intra-articular pathology have been previously reported in up to 100% of patients undergoing combined Hip Arthroscopy and Periacetabular Osteotomy (PAO). 3
4 Purpose The purpose of this study was to examine the types and rate of intra-articular pathology in a large series of patients who have undergone combined Hip Arthroscopy and PAO at a high volume hip preservation center. 4
5 Methods Prospectively collected data was analyzed to determine the types and rate of intra-articular pathology for 73 consecutive patients (76 hips) who underwent combined Hip Arthroscopy and PAO at a single academic medical center from June 2012 through February Charts were reviewed for operative records describing intra-articular pathology encountered at the time of Hip Arthroscopy. 5
6 Capsule Thickness Ease of Distension NORMAL 11 NORMAL THICK/ CONTRACTED 28 CONTRACTURE THIN/REDUNDANT 17 HYPERDISTENSION 27
7 Synovitis Loose Bodies 3 SYNOVITIS NO SYNOVITIS LOOSE BODY NO LOOSE BODY 70
8 Femoroacetabular Impingement (FAI) Morphology PINCER CAM MIXED NORMAL 43
9 Labral tear Ligamentum Teres Tear LABRAL TEAR NO LABRAL TEAR NO TEAR GRADE 1 TEAR GRADE 2 TEAR GRADE 3 TEAR GRADE 4 TEAR
10 Acetabular Chondromalacia: Grade (%) Acetabular Chondromalacia: Zone (%) GRADE 1 GRADE 2 GRADE 3 GRADE ZONE 1 ZONE 2 ZONE 3 ZONE 4 ZONE 5 1
11 Femoral Chondromalacia: Grade (%) Femoral Chondromalacia: Zone (%) GRADE 1 GRADE 2 GRADE 3 GRADE 4 0 ZONE 1 ZONE 2 ZONE 3 ZONE 4 ZONE 5
12 Conclusions In a large series of patients with acetabular dysplasia undergoing combined Hip Arthroscopy and PAO, a high rate of coexistent intraarticular pathology was identified. Traditional arthrotomy may offer a more limited window into the central compartment, and subsequently fail to address potentially treatable intraarticular pathology. Separate studies are focused on the use of combined Hip Arthroscopy and PAO clinical outcomes through a more comprehensive approach to treating both intra-articular pathology and structural malalignment. 12
13 References Nozawa M, Shitoto K, Matsuda K, Maezawa K, Kurosawa H. Rotational acetabular osteotomy for acetabular dysplasia. A follow-up for more than ten years. J Bone Joint Surg Br Jan;84(1): Cooperman D R, Walensten R, Stulberg S D. Acetabular dysplasia in the adult. Clin Orthop 1983; 175: Clohisy JC, Nunley RM, Curry MC, Schoenecker PL. Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities. J Bone Joint Surg Am Jul;89(7): 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. 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. 2009;24(6 Suppl): Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy. 2003;19: Wenger DR, Bomar JD. Human hip dysplasia: evolution of current treatment concepts. J Orthop Sci. 2003;8: Fujii M, Nakashima Y, Noguchi Y, et al. Effect of intra-articular lesions on the outcome of periacetabular osteotomy in patients with symptomatic hip dysplasia. J Bone Joint Surg Br. Nov;93(11): Nassif NA, Schoenecker PL, Thorsness R, Clohisy JC. Periacetabular Osteotomy and Combined Femoral Head-Neck Junction Osteochondroplasty: A Minimum Two-Year Follow-up Cohort Study. J Bone Joint Surg Am, 2012 Nov 07; 94(21): Botser IB, Smith TW Jr, Nasser R, Domb BG. Open Surgical Dislocation Versus Arthroscopy for Femoroacetabular Impingement: A Comparison of Clinical Outcomes. Arthroscopy Feb; 27(2): Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen YM. Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy? Clin Orthop Relat Res Feb;472(2): Redmond JM, Gupta A, Stake CE, Domb BG. The Prevalence of Hip Labral and Chondral Lesions Identified by Method of Detection During Periacetabular Osteotomy: Arthroscopy Versus Arthrotomy. Arthroscopy Jan 22 13
Combined Hip Arthroscopy and Periacetabular Osteotomy: Intra-Articular Pathology
Combined Hip Arthroscopy and Periacetabular Osteotomy: Intra-Articular Pathology University of Rochester Department of Orthopaedics and Rehabilitation Raymond J. Kenney, MD P. Christopher Cook, MD Kelly
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