Objetivo
Describir los resultados funcionales, radiológicos y la tasa revisión a artroplastia total de cadera en una cohorte de pacientes con displasia de cadera que requirió osteotomía periacetabular como tratamiento aislado o concomitante con artroscopia de cadera.

Método
Estudio de series de casos. Fueron incluidos pacientes intervenidos quirúrgicamente entre 2014 y 2017. Los criterios de inclusión fueron dolor en la cadera y un ángulo lateral de centro borde ≤ 20°. Los criterios de exclusión fueron esqueleto maduro, edad de 40 años o más, cirugía previa de cadera, enfermedad concomitante relacionada con el tejido conectivo y coxartrosis grado ≥ 1 de Tönnis. Todos los pacientes fueron estudiados antes de la cirugía con una radiografía anteroposterior de pelvis, radiografía de falso perfil y resonancia magnética. En caso de pesquisar una lesión intrarticular en resonancia magnética se realizó una artroscopia concomitante a osteotomía periacetabular. La prueba mediana no paramétrica para datos no pareados se utilizó para comparar medidas radiológicas (ángulo del borde central anterior y lateral, ángulo de Tönnis e índice de extrusión) antes y después de la cirugía. El análisis de sobrevida se realizó utilizando la revisión de la artroplastia total de cadera como fracaso. Se estimó la curva de Kaplan Meier. Los datos se procesaron con Stata.

Resultados
Fueron incluidos un total de 15 pacientes consecutivos; Siete pacientes (47%) se sometieron a artroscopia de cadera concomitante, tres de ellos (47%) fueron bilaterales (10 caderas). La mediana de seguimiento fue de 3.5 años (rango, 2 a 8 años). La mediana de edad fue de 20 (rango 13 a 32). El ángulo de cobertura lateral preoperatorio era de 12° (rango, -29° a 19°) y posterior a la cirugía fue de 25° (rango, 8° a 34°), logrando una mediana de corrección de 16° (rango, 7° a 53°). El labrum fue reparado en seis casos (60%). Tres pacientes (15%) requirieron revisión con artroplastia de cadera, y no se informan complicaciones relacionadas con la artroscopia en esta serie.

Conclusión
Realizar una artroscopia concomitante con osteotomía periacetabular no afectó la corrección acetabular, ni el resultado clínico. Hoy en día, debido a la falta de evidencia concluyente, el realizar una artroscopía es una decisión que debe ser tomada caso a caso para un tratamiento integral.

Authors: Cristian Barrientos[1,2], Julián Brañes[1,2], Rodrigo Olivares[2], Rodrigo Wulf[1], Álvaro Martinez[2], Jaime Hinzpeter[1], Maximiliano Barahona[1]

Affiliation:
[1] Departamento de Ortopedia y Traumatología en Hospital Clínico Universidad de Chile, Santiago, Chile
[2] Departamento de Ortopedia y Traumatología en Hospital San José, Santiago, Chile

E-mail: maxbarahonavasquez@gmail.com

Author address:
[1] Santos Dumont 999, 3rd Floor, office 351
Independencia, Santiago,
Chile
Postal code: 8380456

Citation: Barrientos C, Brañes J, Olivares R, Wulf R, Martinez A, Hinzpeter J, et al. Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up. Medwave 2020;20(11):e8082 doi: 10.5867/medwave.2020.11.8082

Submission date: 16/5/2020

Acceptance date: 19/10/2020

Publication date: 23/12/2020

Origin: Not commissioned

Type of review: Externally peer-reviewed by three reviewers, double-blind

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1. Breidel KE, Coobs BR. Evaluating and managing acetabular dysplasia in adolescents and young adults. JAAPA. 2019 Aug;32(8):32-37. | CrossRef | PubMed |
2. Blankespoor M, Ferrell K, Reuter A, Reuter S. Developmental Dysplasia of the Hip in Infants - A Review for Providers. S D Med. 2020 May;73(5):223-227. | PubMed |
3. Gobierno de Chile, Ministerio de Salud. Guía Clínica displasia luxante de cadera: diagnóstico y tratamiento precoz. Santiago: Minsal, 2010. [On line]. | Link |
4. Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013 Jan;8(1):11-54. | CrossRef | PubMed |
5. Schmitz MR, Murtha AS, Clohisy JC; ANCHOR Study Group. Developmental Dysplasia of the Hip in Adolescents and Young Adults. J Am Acad Orthop Surg. 2020 Feb 1;28(3):91-101. | CrossRef | PubMed |
6. Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005 Feb;87(2):254-9. | CrossRef | PubMed |
7. Jakobsen SS, Overgaard S, Søballe K, Ovesen O, Mygind-Klavsen B, Dippmann CA, et al. The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. EFORT Open Rev. 2018 Jul 11;3(7):408-417. | CrossRef | PubMed |
8. Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009 Aug;467(8):2041-52. | CrossRef | PubMed |
9. Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am. 2011 May;93 Suppl 2:17-21. | CrossRef | PubMed |
10. Pascual-Garrido C, Harris MD, Clohisy JC. Innovations in Joint Preservation Procedures for the Dysplastic Hip "The Periacetabular Osteotomy". J Arthroplasty. 2017 Sep;32(9S):S32-S37. | CrossRef | PubMed |
11. Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res. 2004 Jan;(418):3-8. | PubMed |
12. Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008 Jul;466(7):1633-44. | CrossRef | PubMed |
13. 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 Sep;91(9):2113-23. | CrossRef | PubMed |
14. 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 Jul;39 Suppl:72S-8S. | CrossRef | PubMed |
15. Redmond JM, Gupta A, Stake CE, Domb BG. The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy: arthroscopy versus arthrotomy. Arthroscopy. 2014 Mar;30(3):382-8. | CrossRef | PubMed |
16. Hartig-Andreasen C, Søballe K, Troelsen A. The role of the acetabular labrum in hip dysplasia. A literature overview. Acta Orthop. 2013 Feb;84(1):60-4. | CrossRef | PubMed |
17. Adler KL, Giordano BD. The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review. Arthroscopy. 2019 Jan;35(1):237-248. | CrossRef | PubMed |
18. Lodhia P, Chandrasekaran S, Gui C, Darwish N, Suarez-Ahedo C, Domb BG. Open and Arthroscopic Treatment of Adult Hip Dysplasia: A Systematic Review. Arthroscopy. 2016 Feb;32(2):374-83. | CrossRef | PubMed |
19. Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008 Nov;90 Suppl 4(Suppl 4):47-66. | CrossRef | PubMed |
20. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol. 2007 Jun;188(6):1540-52. | CrossRef | PubMed |
21. Ilizaliturri VM. Arthroscopic treatment of FAI: Position, portals, and instrumentation. In: Femoroacetabular Impingement. Springer-Verlag Berlin Heidelberg; 2012:99–111. | CrossRef |
22. Matsuda DK, Villamor A. The modified mid-anterior portal for hip arthroscopy. Arthrosc Tech. 2014 Jul 28;3(4):e469-74. | CrossRef | PubMed |
23. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004 Jan;(418):67-73. | PubMed |
24. Maldonado DR, LaReau JM, Lall AC, Battaglia MR, Mohr MR, Domb BG. Concomitant Arthroscopy With Labral Reconstruction and Periacetabular Osteotomy for Hip Dysplasia. Arthrosc Tech. 2018 Oct 15;7(11):e1141-e1147. | CrossRef | PubMed |
25. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833-40. | PubMed |
26. Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003 May 30;4:10. | CrossRef | PubMed |
27. Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen YM. Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy? Clin Orthop Relat Res. 2014 Feb;472(2):674-80. | CrossRef | PubMed |
28. Fukui K, Briggs KK, Trindade CA, Philippon MJ. Outcomes After Labral Repair in Patients With Femoroacetabular Impingement and Borderline Dysplasia. Arthroscopy. 2015 Dec;31(12):2371-9. | CrossRef | PubMed |
29. Kuhns BD, Weber AE, Levy DM, Bedi A, Mather RC 3rd, Salata MJ, et al. Capsular Management in Hip Arthroscopy: An Anatomic, Biomechanical, and Technical Review. Front Surg. 2016 Mar 4;3:13. | CrossRef | PubMed |
30. Bayne CO, Stanley R, Simon P, Espinoza-Orias A, Salata MJ, Bush-Joseph CA, et al. Effect of capsulotomy on hip stability-a consideration during hip arthroscopy. Am J Orthop (Belle Mead NJ). 2014 Apr;43(4):160-5. | PubMed |
31. Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, et al. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med. 2011 Jul;39 Suppl:85S-91S. | CrossRef | PubMed |
32. Kraeutler MJ, Goodrich JA, Fioravanti MJ, Garabekyan T, Mei-Dan O. The "Outside-In" Lesion of Hip Impingement and the "Inside-Out" Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury. Am J Sports Med. 2019 Oct;47(12):2978-2984. | CrossRef | PubMed |
33. Domb BG, El Bitar YF, Lindner D, Jackson TJ, Stake CE. Arthroscopic hip surgery with a microfracture procedure of the hip: clinical outcomes with two-year follow-up. Hip Int. 2014 Sep-Oct;24(5):448-56. | CrossRef | PubMed |
34. Domb BG, Redmond JM, Dunne KF, Stake CE, Gupta A. A matched-pair controlled study of microfracture of the hip with average 2-year follow-up: do full-thickness chondral defects portend an inferior prognosis in hip arthroscopy? Arthroscopy. 2015 Apr;31(4):628-34. | CrossRef | PubMed |
35. Sansone M, Ahldén M, Jonasson P, Thomeé C, Swärd L, Collin D, et al. Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis-A prospective study. J Hip Preserv Surg. 2015 Dec 26;3(1):61-7. | CrossRef | PubMed |
36. Más Martínez J, Sanz-Reig J, Verdú Román CM, Bustamante Suárez de Puga D, Morales Santías M, Martínez Giménez E. Arthroscopic hip surgery with a microfracture procedure of acetabular full-thickness chondral damage. Cohort study with a 3-year follow-up. Rev Esp Cir Ortop Traumatol. 2018 Mar 10:S1888-4415(18)30018-3. | CrossRef | PubMed |
37. Anwander H, Siebenrock KA, Tannast M, Steppacher SD. Labral Reattachment in Femoroacetabular Impingement Surgery Results in Increased 10-year Survivorship Compared With Resection. Clin Orthop Relat Res. 2017 Apr;475(4):1178-1188. | CrossRef | PubMed |
38. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction. Clin Sports Med. 2011 Apr;30(2):317-29. | CrossRef | PubMed |

Breidel KE, Coobs BR. Evaluating and managing acetabular dysplasia in adolescents and young adults. JAAPA. 2019 Aug;32(8):32-37. | CrossRef | PubMed |

Blankespoor M, Ferrell K, Reuter A, Reuter S. Developmental Dysplasia of the Hip in Infants - A Review for Providers. S D Med. 2020 May;73(5):223-227. | PubMed |

Gobierno de Chile, Ministerio de Salud. Guía Clínica displasia luxante de cadera: diagnóstico y tratamiento precoz. Santiago: Minsal, 2010. [On line]. | Link |

Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health. 2013 Jan;8(1):11-54. | CrossRef | PubMed |

Schmitz MR, Murtha AS, Clohisy JC; ANCHOR Study Group. Developmental Dysplasia of the Hip in Adolescents and Young Adults. J Am Acad Orthop Surg. 2020 Feb 1;28(3):91-101. | CrossRef | PubMed |

Clohisy JC, Barrett SE, Gordon JE, Delgado ED, Schoenecker PL. Periacetabular osteotomy for the treatment of severe acetabular dysplasia. J Bone Joint Surg Am. 2005 Feb;87(2):254-9. | CrossRef | PubMed |

Jakobsen SS, Overgaard S, Søballe K, Ovesen O, Mygind-Klavsen B, Dippmann CA, et al. The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip. EFORT Open Rev. 2018 Jul 11;3(7):408-417. | CrossRef | PubMed |

Clohisy JC, Schutz AL, St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review. Clin Orthop Relat Res. 2009 Aug;467(8):2041-52. | CrossRef | PubMed |

Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. J Bone Joint Surg Am. 2011 May;93 Suppl 2:17-21. | CrossRef | PubMed |

Pascual-Garrido C, Harris MD, Clohisy JC. Innovations in Joint Preservation Procedures for the Dysplastic Hip "The Periacetabular Osteotomy". J Arthroplasty. 2017 Sep;32(9S):S32-S37. | CrossRef | PubMed |

Ganz R, Klaue K, Vinh TS, Mast JW. A new periacetabular osteotomy for the treatment of hip dysplasias: technique and preliminary results. 1988. Clin Orthop Relat Res. 2004 Jan;(418):3-8. | PubMed |

Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008 Jul;466(7):1633-44. | CrossRef | PubMed |

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 Sep;91(9):2113-23. | CrossRef | PubMed |

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 Jul;39 Suppl:72S-8S. | CrossRef | PubMed |

Redmond JM, Gupta A, Stake CE, Domb BG. The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy: arthroscopy versus arthrotomy. Arthroscopy. 2014 Mar;30(3):382-8. | CrossRef | PubMed |

Hartig-Andreasen C, Søballe K, Troelsen A. The role of the acetabular labrum in hip dysplasia. A literature overview. Acta Orthop. 2013 Feb;84(1):60-4. | CrossRef | PubMed |

Adler KL, Giordano BD. The Utility of Hip Arthroscopy in the Setting of Acetabular Dysplasia: A Systematic Review. Arthroscopy. 2019 Jan;35(1):237-248. | CrossRef | PubMed |

Lodhia P, Chandrasekaran S, Gui C, Darwish N, Suarez-Ahedo C, Domb BG. Open and Arthroscopic Treatment of Adult Hip Dysplasia: A Systematic Review. Arthroscopy. 2016 Feb;32(2):374-83. | CrossRef | PubMed |

Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008 Nov;90 Suppl 4(Suppl 4):47-66. | CrossRef | PubMed |

Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis--what the radiologist should know. AJR Am J Roentgenol. 2007 Jun;188(6):1540-52. | CrossRef | PubMed |

Ilizaliturri VM. Arthroscopic treatment of FAI: Position, portals, and instrumentation. In: Femoroacetabular Impingement. Springer-Verlag Berlin Heidelberg; 2012:99–111. | CrossRef |

Matsuda DK, Villamor A. The modified mid-anterior portal for hip arthroscopy. Arthrosc Tech. 2014 Jul 28;3(4):e469-74. | CrossRef | PubMed |

Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004 Jan;(418):67-73. | PubMed |

Maldonado DR, LaReau JM, Lall AC, Battaglia MR, Mohr MR, Domb BG. Concomitant Arthroscopy With Labral Reconstruction and Periacetabular Osteotomy for Hip Dysplasia. Arthrosc Tech. 2018 Oct 15;7(11):e1141-e1147. | CrossRef | PubMed |

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833-40. | PubMed |

Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003 May 30;4:10. | CrossRef | PubMed |

Domb BG, Lareau JM, Baydoun H, Botser I, Millis MB, Yen YM. Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy? Clin Orthop Relat Res. 2014 Feb;472(2):674-80. | CrossRef | PubMed |

Fukui K, Briggs KK, Trindade CA, Philippon MJ. Outcomes After Labral Repair in Patients With Femoroacetabular Impingement and Borderline Dysplasia. Arthroscopy. 2015 Dec;31(12):2371-9. | CrossRef | PubMed |

Kuhns BD, Weber AE, Levy DM, Bedi A, Mather RC 3rd, Salata MJ, et al. Capsular Management in Hip Arthroscopy: An Anatomic, Biomechanical, and Technical Review. Front Surg. 2016 Mar 4;3:13. | CrossRef | PubMed |

Bayne CO, Stanley R, Simon P, Espinoza-Orias A, Salata MJ, Bush-Joseph CA, et al. Effect of capsulotomy on hip stability-a consideration during hip arthroscopy. Am J Orthop (Belle Mead NJ). 2014 Apr;43(4):160-5. | PubMed |

Myers CA, Register BC, Lertwanich P, Ejnisman L, Pennington WW, Giphart JE, et al. Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. Am J Sports Med. 2011 Jul;39 Suppl:85S-91S. | CrossRef | PubMed |

Kraeutler MJ, Goodrich JA, Fioravanti MJ, Garabekyan T, Mei-Dan O. The "Outside-In" Lesion of Hip Impingement and the "Inside-Out" Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury. Am J Sports Med. 2019 Oct;47(12):2978-2984. | CrossRef | PubMed |

Domb BG, El Bitar YF, Lindner D, Jackson TJ, Stake CE. Arthroscopic hip surgery with a microfracture procedure of the hip: clinical outcomes with two-year follow-up. Hip Int. 2014 Sep-Oct;24(5):448-56. | CrossRef | PubMed |

Domb BG, Redmond JM, Dunne KF, Stake CE, Gupta A. A matched-pair controlled study of microfracture of the hip with average 2-year follow-up: do full-thickness chondral defects portend an inferior prognosis in hip arthroscopy? Arthroscopy. 2015 Apr;31(4):628-34. | CrossRef | PubMed |

Sansone M, Ahldén M, Jonasson P, Thomeé C, Swärd L, Collin D, et al. Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis-A prospective study. J Hip Preserv Surg. 2015 Dec 26;3(1):61-7. | CrossRef | PubMed |

Más Martínez J, Sanz-Reig J, Verdú Román CM, Bustamante Suárez de Puga D, Morales Santías M, Martínez Giménez E. Arthroscopic hip surgery with a microfracture procedure of acetabular full-thickness chondral damage. Cohort study with a 3-year follow-up. Rev Esp Cir Ortop Traumatol. 2018 Mar 10:S1888-4415(18)30018-3. | CrossRef | PubMed |

Anwander H, Siebenrock KA, Tannast M, Steppacher SD. Labral Reattachment in Femoroacetabular Impingement Surgery Results in Increased 10-year Survivorship Compared With Resection. Clin Orthop Relat Res. 2017 Apr;475(4):1178-1188. | CrossRef | PubMed |

Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction. Clin Sports Med. 2011 Apr;30(2):317-29. | CrossRef | PubMed |