No One is Fooling Around: Scope It First! I (and/or my co-authors) - - PowerPoint PPT Presentation

No One is Fooling Around: Scope It First!

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What is Borderline Dysplasia?

• Most describe borderline dysplasia

using radiographic parameters

• LCEA between 18-25°
• Tönnis angle between 10-14°
• There are dysplasia variants that

may push you to consider open surgery

• Femoral sided deformities
• Acetabular orientation
• Treatment decision making is

complex as there may be overlap between dysplasia and FAIS

Which Is It?

FAIS Dysplasia

Is There a Role for Isolated Hip Arthroscopy in Dysplasia?

Parvizi et al. J Arthroplasty 2009.

• 36 Hips for dysplasia (DDH in 30;

Retroversion in 6) and FAI underwent HA labral debridement and osteoplasty

• Improvement at 6 wks then

deteriorated over time

• 13 Femoral head migration
• 14 Accelerated OA

Mei-Dan et al. Arthroscopy 2012.

Is There a Role for Isolated Hip Arthroscopy in Dysplasia?

Matsuda at el. Arthroscopy 2012.

• 2 cases of rapid acceleration of hip

OA

Mei-Dan et al. Catastrophic Failure in Hip Arthroscopy Due to Iatrogenic Instability: Can Partial Division of Lig Teres and Iliofemoral Ligament Cause Subluxation? Arthroscopy 2012.

Matsuda et al. Arthroscopy 2012.

• 48 patients with LCEA < 25° with

mean 27 months s/p labral debridement, chondroplasty / MFX

• 16 Dysplasia (< 20°)
• MHHS 57  83
• 32 Borderline (20-25°)
• MHHS 50  77
• 2 Converted THA
• Dysplasia is not a

contraindication for hip arthroscopy

Byrd et al. Arthroscopy 2003.

Hip Arthroscopy in Dysplasia

Dysplasia Cohort

88 Cases with 71% Female

• LCEA 20.8° (range, 8.7°-24.5°)
• Tonnis Angle 11° (range, 0°-22.2°)

Outcomes

• MHHS 81.3
• 60.9% Good to Excellent
• Labral and capsular repair
• MHHS 85
• 73% Good to Excellent

FAIS Cohort

231 Cases with 52% Female Outcomes

• MHHS 88.4
• 81.2% Good to Excellent

Predictors of Failure (PAO/THA or MHHS < 70): Grade 4 chondral defects

Larson et al. AJSM 2015.

Borderline Dysplasia

Borderline dysplasia

• Domb et al. AJSM 2013.
• 26 patients with CEA 22.2°

(range, 18-25°) underwent HA with labral repair and capsular plication

• 77% (17/22) G/E outcome
• 14% (3/22) Tonnis 0  1
• 9% (2/22) Revision

Outcomes After Hip Arthroscopy for Borderline Dysplasia

• HSS Experience with 55 cases

hip arthroscopy and capsular closure for BD with 31 months follow up (Nawabi et al. AJSM 2016)

LCEA Tonnis Alpha BD 22.4° 6.3° 66.3° Control 31.0° 2.2° 61.7°

• Significant improvement in all

PRO for both groups

• 2 Revision Hip Arthroscopy
• Rush Experience with 36 cases

hip arthroscopy and capsular closure for BD with 2.6 yr follow up (Cvetanovich et al. AJSM 2017)

LCEA Tonnis Alpha BD 23.4° N/A 60.3° Control 32.5° N/A 62.2°

• Significant improvement in all

PRO for both groups

• 1 Revision Hip Arthroscopy

Male with Borderline Dysplasia

17 yr old elite level hockey goalie with bilateral hip pain

• Plays in the butterfly stance
• Attempted therapy but

symptoms not improved Physical Exam

• ROM
• Flexion 0 – 100°
• ER 30°
• IR 10°
• Positive FADIR
• Full strength

CAM Deformities

Right Alpha 62° Left Alpha 69°

Right Hip

Pre-Op Post-Op

Left Hip

Pre-Op Post-Op

Female with Borderline Dysplasia

• 15 yr old HS soccer player with history of dysplasia s/p Pavlik harness

as an infant complains of right anterior hip pain.

• C sign
• Pain worse running and kicking
• Pain worse with sitting, standing, walking, shoes and socks, in and out of car
• Clicking and popping

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Female with Borderline Dysplasia

Scope First!

• Based on the best evidence

available, using contemporary techniques in hip arthroscopy (labral refixation and capsular plication), borderline dysplasia (LCEA > 18°, Tonnis < 10°) hips should undergo hip arthroscopy in the majority of cases.

• Males with large femoral head/CAM

with low volume acetabulum

• Females with hypermobility
• Use caution when the case may

have multiple features of dysplasia

• LCEA < 18°
• Tonnis angle > 15°
• Break in Shenton’s Line
• Femoral head extrusion/lateralization
• Femoral valgus / anteversion
• Beighton score > 4
• Refer to an open hip preservation

surgeon for cases concerning of dyplasia

Shane J. Nho, MD, MS Shane.nho@rushortho.com