Outcomes of rotational acetabular osteotomy with concomitant hip arthroscopy for severe acetabular dysplasia: a case series of 11 hips with a minimum of 10 years of follow-up.

Abstract

Favorable outcomes of pelvic osteotomy (PO) with concomitant hip arthroscopy (AS) have been reported. As severe acetabular dysplasia (AD) entails risk of postoperative instability due to the difficulty of improving acetabular coverage, the choice to add AS, which has a potential to induce joint instability, should be carefully considered. This study evaluated the long-term outcomes of a PO procedure known as rotational acetabular osteotomy (RAO) with AS in patients with severe AD. A retrospective review was performed of the medical records of consecutive patients with severe AD (lateral center-edge angle < 0° and a break in the Shenton line) who underwent RAO with AS at the authors' hospital between April 2011 and December 2013. Arthroscopic procedures were performed without interportal capsulotomy to minimize the risk of aggravating joint instability. This study used the visual analog scale (VAS) score for hip pain, the modified Harris Hip Score (mHHS), and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score. RAO with AS was performed on 11 consecutive hips of 10 Japanese patients with severe AD, all of whom were followed up (average duration of 151.8 months at the time of analysis). Labrum repair was performed in 27% of the patients, and labrum tear debridement was performed in 73%. None required conversion to total hip replacement. All patients showed statistically significant improvements in VAS, mHHS, and JHEQ (7 (1-9.5) to 2 (0.3-6.0), P = 0.009; 64.5 ± 18.3 to 87.1 ± 9.3, P = 0.002; 40.1 ± 18.0 to 66.9 ± 9.9, P < 0.001, respectively). This study demonstrates favorable long-term outcomes of RAO with concomitant AS in patients with severe AD, though the results should be interpreted with caution because of the small sample size. IV, case series.