Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up.

PURPOSE: To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS: Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS: A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION: To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

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.

High congenital hip dislocation in adults - arthroplasty and functional results.

OBJECTIVE: Retrospective case-control study on the authors' experience regarding arthroplasty in high congenital dislocations of the hip in adults. METHODS: Sample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32 ± 2.67 years (minimum one year) and all patients were evaluated by the same examiner. RESULTS: All the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55 ± 4.50 (range 81-94). The mean time with high dislocation of the hip (42.91 ± 14.59 years, range 19-68) showed a significant inverse correlation with Harris Hip Score (r = 0.80; p = 0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27 ± 0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. CONCLUSION: Despite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

OBJETIVO: Estudo retrospectivo sobre a experiência dos autores no uso de artroplastias para o tratamento de luxações congênitas altas da anca. MÉTODOS: Amostra com 11 luxações congênitas altas da anca (Hartofilakidis tipo C) verificadas em sete pacientes, que foram submetidos a artroplastia da anca pelo mesmo cirurgião com a mesma técnica cirúrgica. O tempo de seguimento médio foi de 4,32 ± 2,67 anos (mínimo um ano) e todos os pacientes foram avaliados pelo mesmo médico. RESULTADOS: Todas as próteses tiveram fixação não cimentada, usaram-se cúpulas acetabulares aparafusadas, hastes femorais cônicas e par articular metal-polietileno. Em todos os pacientes foram efetuadas osteotomias de encurtamento femoral no nível subtrocantérico ou supracondiliano. O Harris Hip Score médio no momento da última avaliação clínica foi de 88,55 ± 4,50 (intervalo 81-94). O tempo de duração da luxação alta da anca (42,91 ± 14,59 anos, intervalo 19-68) demonstrou uma correlação inversa significativa com o Harris Hip Score (r = 0,80; p = 0,003). Todos os pacientes relataram alívio importante das queixas álgicas e todos são capazes de deambular sem qualquer apoio exterior. Nas luxações unilaterais, conseguiu-se correção completa da dismetria e nas bilaterais, membros isométricos em todos os pacientes. Todas as osteotomias consolidaram em tempo médio de 3,27 ± 0,47 meses. Verificaram-se complicações em 18,18% da amostra: uma fratura iatrogênica intraoperatória do grande trocânter e uma neuropráxia transitória do ciático. CONCLUSÃO: Apesar de ser uma cirurgia exigente e com elevado índice de complicações relatado, a artroplastia da anca na luxação congênita alta, quando devidamente indicada e tecnicamente bem executada, permite melhorar a funcionalidade e qualidade de vida dos pacientes.

Periacetabular osteotomy with concomitant hip arthroscopy: a case series with 24 months minimum follow-up

PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.

High congenital hip dislocation in adults - arthroplasty and functional results / Luxações congênitas altas da anca no adulto - Artroplastia e resultados funcionais

ABSTRACT Objective: Retrospective case-control study on the authors' experience regarding arthroplasty in high congenital dislocations of the hip in adults. Methods: Sample with 11 high congenital hip dislocations (Hartofilakidis type C) that occurred in seven patients, who were submitted to hip arthroplasty by the same surgeon and with the same surgical technique. Mean follow-up period was 4.32 ± 2.67 years (minimum one year) and all patients were evaluated by the same examiner. Results: All the arthroplasties had cementless fixation, with application of screwed acetabular cups, conical femoral stems, and a metal-polyethylene articular pars. In every patient, shortening femoral osteotomies were performed at subtrochanteric or supracondylar locations. The mean Harris Hip Score at the last evaluation was 88.55 ± 4.50 (range 81-94). The mean time with high dislocation of the hip (42.91 ± 14.59 years, range 19-68) showed a significant inverse correlation with Harris Hip Score (r = 0.80; p = 0.003). All patients reported important relief of pain complaints and are capable of ambulation without any external support. In the unilateral dislocations, leg length discrepancies were fully corrected; in the bilateral cases, isometric limbs were achieved in all patients. All osteotomies consolidated, with a mean interval of 3.27 ± 0.47 months. There were complications in 18.18% of the sample: one iatrogenic intraoperative fracture of the greater trochanter and a transitory sciatic neurapraxia. Conclusion: Despite being a demanding surgery with a reportedly high complication rate, total hip arthroplasty in high congenital dislocations, when properly indicated and technically correctly performed, allows an improvement in function and quality of life.

RESUMO Objetivo: Estudo retrospectivo sobre a experiência dos autores no uso de artroplastias para o tratamento de luxações congênitas altas da anca. Métodos: Amostra com 11 luxações congênitas altas da anca (Hartofilakidis tipo C) verificadas em sete pacientes, que foram submetidos a artroplastia da anca pelo mesmo cirurgião com a mesma técnica cirúrgica. O tempo de seguimento médio foi de 4,32 ± 2,67 anos (mínimo um ano) e todos os pacientes foram avaliados pelo mesmo médico. Resultados: Todas as próteses tiveram fixação não cimentada, usaram-se cúpulas acetabulares aparafusadas, hastes femorais cônicas e par articular metal-polietileno. Em todos os pacientes foram efetuadas osteotomias de encurtamento femoral no nível subtrocantérico ou supracondiliano. O Harris Hip Score médio no momento da última avaliação clínica foi de 88,55 ± 4,50 (intervalo 81-94). O tempo de duração da luxação alta da anca (42,91 ± 14,59 anos, intervalo 19-68) demonstrou uma correlação inversa significativa com o Harris Hip Score (r = 0,80; p = 0,003). Todos os pacientes relataram alívio importante das queixas álgicas e todos são capazes de deambular sem qualquer apoio exterior. Nas luxações unilaterais, conseguiu-se correção completa da dismetria e nas bilaterais, membros isométricos em todos os pacientes. Todas as osteotomias consolidaram em tempo médio de 3,27 ± 0,47 meses. Verificaram-se complicações em 18,18% da amostra: uma fratura iatrogênica intraoperatória do grande trocânter e uma neuropráxia transitória do ciático. Conclusão: Apesar de ser uma cirurgia exigente e com elevado índice de complicações relatado, a artroplastia da anca na luxação congênita alta, quando devidamente indicada e tecnicamente bem executada, permite melhorar a funcionalidade e qualidade de vida dos pacientes.