While there is a lack of consensus in the literature on what the best treatment option is for patients with borderline developmental hip dysplasia, a new study recommends that doctors, when weighing surgical options, should consider preoperative patient characteristics and concomitant injuries.
Best Care for Borderline Developmental Hip Dysplasia Is…?
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Secondary#arthroscopicsurgery#borderlinedevelopmentalhipdysplasia#periacetabularosteotomy
The systematic review, “Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip: A Systematic Review,” was published online on May 4, 2021 in the Orthopaedic Journal of Sports Medicine.
The researchers analyzed data on patient characteristics, procedures, clinical outcomes and failure rates for patients with borderline developmental hip dysplasia (BDDH) to determine where periacetabular osteotomy or arthroscopic surgery offered better outcomes.
“The treatment for borderline developmental dysplasia of the hip (BDDH) has historically been arthroscopic surgery or periacetabular osteotomy (PAO). As orthopaedic surgery is constantly evolving, a lack of comparison of outcomes for these 2 treatment methods could potentially be stalling the progression of treatment for patients with BDDH,” the researchers wrote.
Twelve studies were included in the review. Ten were on arthroscopic surgery and two were on periacetabular osteotomy. Six of the studies included patients with a lateral center-edge angle of 18˚to 25˚; the rest had patients with a lateral center-edge angle of 20˚ to 25˚.
The arthroscopic surgery studies reported concomitant/accessory procedures while the periacetabular osteotomy studies did not.
Overall, patient-reported outcome measures improved with both procedures. The need for revision surgery, however, was also common.
“It is unknown whether it is more imperative to perform bony coverage correction or soft tissue repair (LT, labrum, capsule, etc.) in patients with BDDH. In an attempt to determine whether one injury is of more importance than is the other, surgeons have begun to use new surgical methods to rectify BDDH abnormalities and injuries,” the researchers wrote.
“In 2018, Yamada et al reported on using endoscopic shelf acetabuloplasty for the treatment of BDDH. This treatment method involves the repair of intra-articular chondrolabral abnormalities, cam or pincer impingement, and anterolateral acetabular shelf coverage. The method of Yamada et al mimics that of the one described by Uchida et al in their study covering endoscopic shelf acetabuloplasty. This particular method of treating patients with BDDH is of consequence because it combines all the effective portions of the different surgical interventions used in the past to treat patients with BDDH: labral repair, cam osteochondroplasty, capsular plication, and shelf acetabuloplasty.”
They concluded that “preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes.”
And. “…in addition, new surgical methods require further research to determine their efficacy in the treatment of patients with BDDH.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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