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. 2014 Feb;472(2):674-80.
doi: 10.1007/s11999-013-3140-2.

Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?

Benjamin G Domb  1 , Justin M Lareau, Hasan Baydoun, Itamar Botser, Michael B Millis, Yi-Meng Yen
Affiliations

Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?

Benjamin G Domb et al. Clin Orthop Relat Res. 2014 Feb.

Abstract

Background: Periacetabular osteotomy (PAO) enables correction of bony acetabular deficiency in the setting of hip dysplasia. Patients with insufficient acetabular coverage often have intraarticular pathology, but the degree of this pathology has been incompletely characterized. We have used arthroscopy as an adjunct to PAO to further delineate intraarticular pathology in patients with hip dysplasia with mechanical symptoms.

Questions/purposes: We documented the arthroscopic incidence of (1) femoral and acetabular chondral pathology, (2) femoral neck cam lesions, and (3) internal snapping or ligamentum teres pathology among patients having arthroscopy before PAO.

Methods: We reviewed all 16 patients (17 hips; mean age at surgery, 21 years; range, 12-33 years) with hip dysplasia who underwent PAOs and concomitant hip arthroscopy at our institutions from October 2010 to March 2012. During this period, 80 patients underwent PAOs, making the arthroscopic cohort 21% of the total cohort. Indications for concomitant hip arthroscopy were mechanical symptoms consistent with labral pathology identified on MRI. We documented pathology involving the labrum, chondral surface, ligamentum teres, cam deformity, and psoas tendon.

Results: Arthroscopy revealed significant intraarticular pathology in all patients. Fourteen hips had anterosuperior labral tears, and three hips had preoperative findings of internal snapping hip. Eleven hips had femoral cam-type lesions in addition to dysplasia, and 16 hips had articular chondral injury. Two hips had full-thickness ligamentum tears, and 13 hips had partial-thickness tears.

Conclusions: Intraarticular pathology at the time of PAO is common. Future studies are needed to rigorously address the use of arthroscopic intervention during PAO and the impact on clinical outcome compared to PAO alone.

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Figures

Fig. 1A–B
Fig. 1A–B
(A) In a preoperative standing AP radiograph, the lateral center-edge angle measures 13°. (B) In a preoperative false-profile view, the anterior center-edge angle measures 11°.
Fig. 2
Fig. 2
An arthroscopic view shows fraying of the ligamentum teres suggestive of microinstability (arrow). The asterisk is the articular surface of the femoral head.
Fig. 3A–B
Fig. 3A–B
(A) In a postoperative AP radiograph, the lateral center-edge angle measures 23°. (B) In a postoperative false-profile view, the anterior center-edge angle measures 23°.
Fig. 4
Fig. 4
In an arthroscopic view, the labrum is hypertrophied and, under the yellowish area of degeneration, has separated from the acetabulum. The asterisk denotes the acetabular cartilage, which is softened.
Fig. 5
Fig. 5
An arthroscopic view shows the repair of the torn labrum shown in Figure 4 using suture anchors to secure the tissue.
See this image and copyright information in PMC

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