Hip Arthroscopy with Labral Preservation and Capsular Plication in Patients with Borderline Hip Dysplasia: Minimum 5-year Patient Reported Outcomes

Abstract

Objectives: Arthroscopic management of hip pathology in patients with hip dysplasia has been controversial, and historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown favorable outcomes. We predicted that patients with borderline dysplasia, who are undergoing hip arthroscopy for intrarticular pathology and who have commensurate labral preservation and capsular plication, will have favorable outcomes at mid-term follow up. Methods: Data was prospectively collected for patients < age 40, who underwent hip arthroscopy for intra-articular pathology. Inclusion criteria included lateral center-edge angle (LCEA) between 18° and 25°, concurrent capsular plication and labral preservation, and minimum five-year follow-up. Exclusion criteria were severe dysplasia (LCEA ≤ 18°), Tönnis grade ≥ 2, preexisting childhood hip conditions, or prior hip surgery. Patient-reported outcome scores (PROs) including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-sport specific subscale (HOS-SSS) and Visual Analogue Score for pain (VAS) were collected preoperatively, at 3 months, and annually thereafter. Complications and revisions were recorded. Results: Twenty-five hips (24 patients) met inclusion criteria. Twenty-one hips (19 patients, 84%) were available for follow-up. Mean age was 22.9 years. Mean preoperative LCEA and Tönnis angle were 21.7° and 6.9°, respectively. Mean follow-up was 68.8 months. Mean mHHS increased from 70.3 to 85.9 (p < 0.0001), NAHS from 68.3 to 87.3 (p < 0.0001) and HOS-SSS from 52.1 to 70.8 (p = 0.0002). VAS improved from 5.6 to 1.8 (p < 0.0001). Four hips (19%) required secondary arthroscopic procedures, all of which resulted in improved PROs at latest follow-up. No patient required conversion to arthroplasty. Conclusion: Using strict patient selection, hip arthroscopy with labral preservation and capsular plication can provide a safe, durable means of managing intra-articular pathology in the setting of borderline acetabular dysplasia. For this select group, this procedure may offer a viable alternative to open surgery (PAO).