Hip Arthroscopy as Treatment for Hip Dysplasia: An Update

Hip Arthroscopy as Treatment for Hip Dysplasia: An Update

Surgical treatment of adult hip dysplasia by arthroscopic surgery alone remains controversial. The IHDI posted an Education Statement in 2012 with an update in 2014 stating that “…hip arthroscopy should usually be avoided as the main treatment for hip problems caused by dysplasia”. [https://hipdysplasia.org/news/hip-arthroscopy-alone-is-rarely-helpful-for-patients-with-dysplasia/]. This statement is still good advice although more recent studies have helped identify the risks and benefits of isolated hip arthroscopy for managing hip dysplasia.

Some surgeons recommend hip arthroscopy for treatment of labral tears related to hip dysplasia because hip arthroscopy is a “lesser” or minimally invasive procedure. These studies are in “mild dysplasia” only, and they are only short-term studies from a few centers.  Also, it is assumed that PAO surgery can be performed if the labral repair fails after arthroscopy, or if pain continues. While this is a seemingly sensible approach, a study published in 2018 found that failed arthroscopy leads to poorer outcomes after PAO surgery when compared to matched patients who never had arthroscopic surgery prior to PAO surgery. [https://www.ncbi.nlm.nih.gov/pubmed/30647927] In other words, hip arthroscopy may be beneficial for some patients, but it probably makes matters worse when PAO surgery is needed later.

Another report was published in the American Journal of Sports Medicine in October, 2017. A Medical Center in England treated 111 patients with hip dysplasia who were carefully selected for treatment by arthroscopic surgery alone. Average follow-up was 4½ years. With careful selection approximately two thirds of the patients still had satisfactory results at follow-up. The authors cautioned against arthroscopic options except in the mildest cases. Specifically, they recommended arthroscopic repair only when three x-ray findings were met: Acetabular Index was greater than 0°, Center-Edge Angle was greater than 15°, and no visible thinning of the joint surfaces.  https://www.ncbi.nlm.nih.gov/pubmed/?term=davies+oli+hip+dysplasia

However, the IHDI recommends caution for hip arthroscopy alone – even for mild dysplasia.  Another report of similar cases found that a Center-Edge Angle of up to 25° was associated with early onset hip arthritis. https://www.ncbi.nlm.nih.gov/pubmed/27071391. Although arthroscopy alone may be suggested for treatment of labral tears in the presence of mild dysplasia, this does not correct the mechanical stresses caused by a shallow socket.

These two papers and others continue to support the IHDI Hip Arthroscopy Education Statement that was developed and posted in 2012. [https://hipdysplasia.org/for-physicians/hip-arthroscopy-for-labral-repair-in-patients-with-hip-dysplasia/] The following sentence from that statement still holds true today and should continue to be accurate:  “Unless the misalignment is corrected, it is highly likely that soft-tissue repairs will break down again. The current procedure of choice for the treatment of hip dysplasia is skeletal re-alignment with procedures such as the Peri-acetabular osteotomy (PAO) instead of arthroscopy as an isolated procedure…”.  There is still a debate whether the labrum needs any treatment at all if a Periacetabular osteotomy (PAO) is performed.  It is also important to point out that any injury to the labrum in a patient with hip dysplasia is likely a result of the increased forces placed on the labrum because of the bony dysplasia and a “repair” will not address the underlying problem.  Arthroscopic surgery may be combined with skeletal re-alignment by osteotomy has shown satisfactory results, but caution is advised when arthroscopic surgery alone is recommended.