Clinical Orthopaedics and Related Research®

, Volume 472, Issue 2, pp 674–680 | Cite as

Is Intraarticular Pathology Common in Patients With Hip Dysplasia Undergoing Periacetabular Osteotomy?

  • Benjamin G. Domb
  • Justin M. Lareau
  • Hasan Baydoun
  • Itamar Botser
  • Michael B. Millis
  • Yi-Meng Yen
Symposium: 2013 Hip Society Proceedings

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.

Level of Evidence

Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

References

  1. 1.
    Akiyama K, Sakai T, Koyanagi J, Yoshikawa H, Sugamoto K. Evaluation of translation in the normal and dysplastic hip using three-dimensional magnetic resonance imaging and voxel-based registration. Osteoarthritis Cartilage. 2011;19:700–710.PubMedCrossRefGoogle Scholar
  2. 2.
    Botser IB, Martin DE, Stout CE, Domb BG. Tears of the ligamentum teres: prevalence in hip arthroscopy using 2 classification systems. Am J Sports Med. 2011;39(suppl):117S–125S.PubMedCrossRefGoogle Scholar
  3. 3.
    Byrd JW. Labral lesions: an elusive source of hip pain case reports and literature review. Arthroscopy. 1996;12:603–612.PubMedCrossRefGoogle Scholar
  4. 4.
    Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy. 2003;19:1055–1060.PubMedCrossRefGoogle Scholar
  5. 5.
    Cerezal L, Arnaiz J, Canga A, Piedra T, Altonaga JR, Munafo R, Perez-Carro L. Emerging topics on the hip: ligamentum teres and hip microinstability. Eur J Radiol. 2011.Google Scholar
  6. 6.
    Clohisy JC, St John LC, Nunley RM, Schutz AL, Schoenecker PL. Combined periacetabular and femoral osteotomies for severe hip deformities. Clin Orthop Relat Res. 2009;467:2221–2227.PubMedCrossRefGoogle Scholar
  7. 7.
    Cooperman DR, Wallensten R, Stulberg SD. Post-reduction avascular necrosis in congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:247–258.PubMedGoogle Scholar
  8. 8.
    Cooperman DR, Wallensten R, Stulberg SD. Acetabular dysplasia in the adult. Clin Orthop Relat Res. 1983;175:79–85.PubMedGoogle Scholar
  9. 9.
    Czubak J. Periacetabular Ganz osteotomy in the treatment of developmental dysplasia of the hip in adolescents and adults: surgical technique and early results. Ortop Traumatol Rehabil. 2004;6:51–59.PubMedGoogle Scholar
  10. 10.
    Czubak J. Periacetabular osteotomy in the treatment of developmental hip dysplasia in adolescents and adults. Ortop Traumatol Rehabil. 2006;8:12–15.PubMedGoogle Scholar
  11. 11.
    Fujii M, Nakashima Y, Jingushi S, Yamamoto T, Noguchi Y, Suenaga E, Iwamoto Y. Intraarticular findings in symptomatic developmental dysplasia of the hip. J Pediatr Orthop. 2009;29:9–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Ganz R, Horowitz K, Leunig M. Algorithm for femoral and periacetabular osteotomies in complex hip deformities. Clin Orthop Relat Res. 2010;468:3168–3180.PubMedCrossRefGoogle Scholar
  13. 13.
    Garras DN, Crowder TT, Olson SA. Medium-term results of the Bernese periacetabular osteotomy in the treatment of symptomatic developmental dysplasia of the hip. J Bone Joint Surg Br. 2007;89:721–724.PubMedCrossRefGoogle Scholar
  14. 14.
    Gudmundsson G. Intertrochanteric displacement osteotomy for painful osteoarthritis of the hip. Acta Orthop Scand. 1970;41:91–109.PubMedCrossRefGoogle Scholar
  15. 15.
    Hadley NA, Brown TD, Weinstein SL. The effects of contact pressure elevations and aseptic necrosis on the long-term outcome of congenital hip dislocation. J Orthop Res. 1990;8:504–513.PubMedCrossRefGoogle Scholar
  16. 16.
    Ilizaliturri VM Jr, Chaidez PA, Valero FS, Aguilera JM. Hip arthroscopy after previous acetabular osteotomy for developmental dysplasia of the hip. Arthroscopy. 2005;21:176–181.PubMedCrossRefGoogle Scholar
  17. 17.
    Ippolito E, Yoshiaki I, Ponseti I. Histologic, histochemical, and ultrastructural studies of the hip joint capsule and ligamentum teres in congenital dislocation of the hip. Clin Orthop Relat Res. 1980;146:246–258.Google Scholar
  18. 18.
    Katz DA, Kim YJ, Millis MB. Periacetabular osteotomy in patients with Down’s syndrome. J Bone Joint Surg Br. 2005;87:544–547.PubMedCrossRefGoogle Scholar
  19. 19.
    Kelly BT, Philippon M. Arthroscopic hip anatomy. In: Callaghan J, Rosenberg A, Rubash H, eds. The Adult Hip. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:78–79.Google Scholar
  20. 20.
    Kim YJ, Jaramillo D, Millis MB, Gray ML, Burstein D. Assessment of early osteoarthritis in hip dysplasia with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. J Bone Joint Surg Am. 2003;85:1987–1992.PubMedCrossRefGoogle Scholar
  21. 21.
    Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome: a clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.PubMedGoogle Scholar
  22. 22.
    Klein SE, Morgan P, Schoenecker PL, Clohisy JC. Arthroscopic treatment of labral tears after a previous Pemberton osteotomy. J Pediatr Orthop. 2010;30:549–553.PubMedCrossRefGoogle Scholar
  23. 23.
    Ladner B, Nester K, Cascio B. Abdominal fluid extravasation during hip arthroscopy. Arthroscopy. 2010;26:131–135.PubMedCrossRefGoogle Scholar
  24. 24.
    Leunig M, Ganz R. [The Bernese method of periacetabular osteotomy] [in German]. Orthopade. 1998;27:743–750.PubMedGoogle Scholar
  25. 25.
    Mardam-Bey TH, MacEwen GD. Congenital hip dislocation after walking age. J Pediatr Orthop. 1982;2:478–486.PubMedCrossRefGoogle Scholar
  26. 26.
    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 Am. 2009;91:2113–2123.PubMedCrossRefGoogle Scholar
  27. 27.
    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: surgical technique. J Bone Joint Surg Am. 2010;92(suppl 1 pt 2):115–129.PubMedGoogle Scholar
  28. 28.
    Maxian TA, Brown TD, Weinstein SL. Chronic stress tolerance levels for human articular cartilage: two nonuniform contact models applied to long-term follow-up of CDH. J Biomech. 1995;28:159–166.PubMedCrossRefGoogle Scholar
  29. 29.
    McCarthy JC, Lee JA. Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res. 2002;405:122–128.PubMedCrossRefGoogle Scholar
  30. 30.
    McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The Otto E. Aufranc Award. The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25–37.PubMedCrossRefGoogle Scholar
  31. 31.
    Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip. Clin Orthop Relat Res. 1970;71:199–201.PubMedCrossRefGoogle Scholar
  32. 32.
    Millis M, Kocher M. Hip, pelvis, femur: pediatric aspects. In: Koval K, ed. Orthopaedic Knowledge Update 7. Chicago, IL: American Academy of Orthopaedic Surgeons; 2002:387–394.Google Scholar
  33. 33.
    Murphy SB, Millis MB, Hall JE. Surgical correction of acetabular dysplasia in the adult: a Boston experience. Clin Orthop Relat Res. 1999;363:38–44.PubMedCrossRefGoogle Scholar
  34. 34.
    Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39:296–303.PubMedCrossRefGoogle Scholar
  35. 35.
    Nishii T, Sugano N, Tanaka H, Nakanishi K, Ohzono K, Yoshikawa H. Articular cartilage abnormalities in dysplastic hips without joint space narrowing. Clin Orthop Relat Res. 2001;383:183–190.PubMedCrossRefGoogle Scholar
  36. 36.
    Noguchi Y, Miura H, Takasugi S, Iwamoto Y. Cartilage and labrum degeneration in the dysplastic hip generally originates in the anterosuperior weight-bearing area: an arthroscopic observation. Arthroscopy. 1999;15:496–506.PubMedCrossRefGoogle Scholar
  37. 37.
    Paliobeis CP, Villar RN. The prevalence of dysplasia in femoroacetabular impingement. Hip Int. 2011;21:141–145.PubMedCrossRefGoogle Scholar
  38. 38.
    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;24:110–113.PubMedCrossRefGoogle Scholar
  39. 39.
    Philippon MJ, Kuppersmith DA, Wolff AB, Briggs KK. Arthroscopic findings following traumatic hip dislocation in 14 professional athletes. Arthroscopy. 2009;25:169–174.PubMedCrossRefGoogle Scholar
  40. 40.
    Ranawat CS, Atkinson RE, Salvati EA, Wilson PD Jr. Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years. J Bone Joint Surg Am. 1984;66:745–752.PubMedGoogle Scholar
  41. 41.
    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. 2011;39(suppl):72S–78S.PubMedCrossRefGoogle Scholar
  42. 42.
    Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240.PubMedCrossRefGoogle Scholar
  43. 43.
    Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect. 2001;50:239–245.PubMedGoogle Scholar
  44. 44.
    Siebenrock KA, Scholl E, Lottenbach M, Ganz R. Bernese periacetabular osteotomy. Clin Orthop Relat Res. 1999;363:9–20.PubMedCrossRefGoogle Scholar
  45. 45.
    Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br. 1976;58:176–183.PubMedGoogle Scholar
  46. 46.
    Trousdale RT, Ekkernkamp A, Ganz R, Wallrichs SL. Periacetabular and intertrochanteric osteotomy for the treatment of osteoarthrosis in dysplastic hips. J Bone Joint Surg Am. 1995;77:73–85.PubMedGoogle Scholar
  47. 47.
    Wiberg G. Acetabular dysplasia and osteoarthritis. Acta Chir Scand. 1939;83(suppl 58):5–135.Google Scholar
  48. 48.
    Yasunaga Y, Ochi M, Terayama H, Tanaka R, Yamasaki T, Ishii Y. Rotational acetabular osteotomy for advanced osteoarthritis secondary to dysplasia of the hip. J Bone Joint Surg Am. 2006;88:1915–1919.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Benjamin G. Domb
    • 1
    • 2
  • Justin M. Lareau
    • 1
  • Hasan Baydoun
    • 3
  • Itamar Botser
    • 1
  • Michael B. Millis
    • 4
  • Yi-Meng Yen
    • 4
    • 5
  1. 1.Hinsdale OrthopaedicsHinsdaleUSA
  2. 2.American Hip Institute in Chicago Loyola University Stritch School of MedicineChicagoUSA
  3. 3.Armstrong County Memorial HospitalKittanningUSA
  4. 4.Department of Orthopaedic Surgery, Child and Adult Hip Unit, Harvard Medical SchoolBoston Children’s HospitalBostonUSA
  5. 5.Department of Orthopaedic Surgery, Division of Sports MedicineBoston Children’s HospitalBostonUSA

Personalised recommendations