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Scientific Articles   |    
Periacetabular Osteotomy After Failed Hip Arthroscopy for Labral Tears in Patients with Acetabular Dysplasia
Michael S.H. Kain, MD1; Eduardo N. Novais, MD2; Clarisa Vallim, MD, ScD2; Michael B. Millis, MD2; Young-Jo Kim, MD, PhD2
1 Department of Orthopaedic Surgery, Lahey Clinic, 41 Mall Road, Burlington, MA 01805
2 Department of Orthopaedic Surgery (E.N.N., M.B.M., and Y.-J.K.) and Clinical Research Program (C.V.), Children's Hospital Boston, Hunnewell 225, 300 Longwood Avenue, Boston, MA 02115. E-mail address for Y.-J. Kim: young-jo.kim@childrens.harvard.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Children's Hospital, Boston, Massachusetts

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 04;93(Supplement 2):57-61. doi: 10.2106/JBJS.J.01770
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Abstract

Background: 

Chronic mechanical overload of the acetabular rim may lead to acetabular labral disease in patients with hip dysplasia. Although arthroscopic debridement of the labrum may provide symptomatic relief, the underlying mechanical abnormality remains. There is little information regarding how the results of periacetabular osteotomy are affected by a prior primary treatment for labral disease in the presence of acetabular dysplasia.

Methods: 

In a retrospective matched-cohort study, seventeen patients who had arthroscopic labral debridement prior to periacetabular osteotomy (the arthroscopy group) were compared with a control group of thirty-four patients who did not undergo arthroscopic labral debridement prior to periacetabular osteotomy (the non-arthroscopy group). Two control patients were randomly matched to each experimental patient from a pool of controls. Functional outcomes were assessed with use of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Failure of periacetabular osteotomy was defined as conversion to a total hip replacement.

Results: 

Changes in the preoperative and postoperative WOMAC scores of arthroscopy and non-arthroscopy patients were comparable, and the differences between the two treatment groups were not significant. We were unable to show a significant difference between the seventeen arthroscopy and thirty-four non-arthroscopy patients with regard to the risk of having to undergo a total hip replacement.

Conclusions: 

When arthroscopic labral debridement fails to improve symptoms in patients with labral disease secondary to acetabular dysplasia, periacetabular osteotomy may still be considered as a joint-preserving procedure that can achieve good functional results.

Level of Evidence: 

Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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