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Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 22 April 2019

This article has been updated

Abstract

Purpose

As indications for hip arthroscopy continue to expand, its efficacy in patients with more complex deformities of the hip, such as those with acetabular dysplasia, remains controversial. The purpose of this systematic review is to identify the predictors of failed hip arthroscopy in dysplastic hips and to propose a standardize prognostic sub-classification of dysplasia.

Methods

This systematic review was performed in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Three databases [EMBASE, PubMed, and Ovid (MEDLINE)] were searched using terms including “hip arthroscopy” and “dysplasia”. Studies were screened and data extracted in duplicate. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Due to the non-uniform nature of study data, findings were presented in descriptive summary form.

Results

Thirteen studies were included in this systematic review, comprising 712 dysplastic patients (773 hips) with mean age 34.2 years and 74.1% females. Most studies defined hip dysplasia by a lateral centre-edge angle (LCEA) of 20°–25° (borderline) or 15°–20° (moderate). Failure was defined as progression to revision arthroscopy, peri-acetabular osteotomy, or total hip arthroplasty. Overall, failure rate was 192/743 (25.8%) at an average of 28.1 months following index arthroscopy. Smaller LCEA, larger Tönnis angle, broken Shenton line, and decreased joint space (≤ 2 mm) were radiographic predictors of failure. Severe cartilage lesions to the femoral head or acetabulum were associated with failure in five studies. Labral debridement led to more failures than labral repair.

Conclusion

Overall, hip arthroscopy yielded good outcomes in mildly dysplastic hips without severe chondral damage. Hip arthroscopy is expected to result in a failed outcome in individuals with moderate-to-severe hip dysplasia (LCEA < 15°), severe cartilage lesions, larger Tönnis angle (> 20°), broken Shenton line, and decreased joint space (≤ 2 mm). Arthroscopic surgery may be more effective in individuals with borderline-to-mild (LCEA 15°–25°) acetabular dysplasia in the absence of severe cartilaginous lesions (7-year survival: 89.6%). A standardized prognostic classification of hip dysplasia based on the LCEA and Tönnis angle is proposed.

Level of evidence

Systematic review of non-randomized studies, Level IV.

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Change history

  • 22 April 2019

    Unfortunately, the author name was incorrectly published in the original publication as Sochi Uchida insted of Soshi Uchida. The author name is corrected here by this Erratum. The ​original ​article ​has ​been ​corrected.

Abbreviations

FAI:

Femoroacetabular impingement

PAO:

Peri-acetabular osteotomy

THA:

Total hip arthroplasty

OA:

Osteoarthritis

LCEA:

Lateral centre-edge angle

MINORS:

Methodological Index for Non-Randomized Studies

FNS:

Femoral neck-shaft

VAS:

Visual Analog Scale

MRI:

Magnetic resonance imaging

LT:

Ligamentum teres

MAHORN:

Multicenter Arthroscopy of the Hip Outcomes Research Network

ICRS:

International cartilage repair society

PROM:

Patient-reported outcome measure

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Acknowledgements

Sincere thanks to the Health Sciences Library at McMaster University for their assistance in creating a valid search strategy.

Funding

No funding was received for the implementation of this study.

Author information

Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Ajay Shah

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Jeffrey Kay, Muzammil Memon, Nicole Simunovic & Olufemi R. Ayeni

  3. Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan

    Soshi Uchida

  4. Department of Hip Surgery, Lyon Ortho Clinic, Clinique de la Sauvegarde, 25B Avenue des Sources, 69009, Lyon, France

    Nicolas Bonin

  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

  6. McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

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Contributions

JK and MM performed the literature search, title, abstract, and full-text screening. AS performed the hand-search of references, data extraction, and wrote several drafts of the manuscript. NB, SU, and ORA thoroughly edited and provided guidance with respect to preparation of the manuscript. ORA conceived the study and participated in its design and coordination. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

ORA is a paid consultant for ConMed. NB is a consultant for Stryker, receives accommodations and travel expenses reimbursement from Smith and Nephew, and receives royalties from Dedienne Sante. SU is a consultant for Smith and Nephew and ConMed. The authors have no other potential conflicts of interests to declare.

Ethical approval

The present study was done in agreement with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical review board approval was not required for this systematic review.

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The original version of this article was revised: Author name was incorrectly published as Sochi Uchida insted of Soshi Uchida in the original publication.

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Shah, A., Kay, J., Memon, M. et al. Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification. Knee Surg Sports Traumatol Arthrosc 28, 1296–1310 (2020). https://doi.org/10.1007/s00167-019-05416-3

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