Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic developmental dysplasia of the hip (DDH) (n=71). Intervention: Hip arthroscopy vs. Open arthrotomy. Primary outcome: Change in 13 patient-reported outcomes (PROs) at 1 year (p=>=0.061).

Cody C. Wyles; Mario Hevesi; D Bartels; Dirk R. Larson; Rafael J. Sierra; Robert T. Trousdale

doi:10.1093/jhps/hny022

June 19, 2018Journal of Hip Preservation SurgeryOpen Access

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

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Key result

Hip arthroscopy and open arthrotomy demonstrated similar improvements across 13 patient-reported outcomes at 1 year when performed during periacetabular osteotomy for hip dysplasia.

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Why the study?

Does hip arthroscopy compared to arthrotomy improve short-term patient-reported outcomes in patients undergoing PAO for hip dysplasia?

Study Design

Type

Cohort (n=71)

Multicenter

No

Structured PICO

Does hip arthroscopy compared to arthrotomy improve short-term patient-reported outcomes in patients undergoing PAO for hip dysplasia?

P

Population

71 patients (87% female, mean age 27.3 years) with symptomatic developmental dysplasia of the hip underwent periacetabular osteotomy with either hip arthroscopy or arthrotomy and were followed for 1 year.

I

Intervention

Hip arthroscopy (HA) to address intra-articular pathology at the time of PAO

C

Comparator

Arthrotomy to address intra-articular pathology at the time of PAO

O

Outcome

13 patient-reported outcomes (PROs)patient reported

Main Result

p-value: p=>=0.061

Arthroscopy and arthrotomy demonstrate similar short-term patient-reported outcomes when addressing intra-articular pathology during periacetabular osteotomy for hip dysplasia.

Limitations

Retrospective design without a control group where intra-articular abnormalities were left untreated.
Each treatment algorithm was performed solely by one surgeon, introducing potential selection and technique bias.
Short-term follow-up of 1 year precludes analysis of long-term natural history.
Patients undergoing arthrotomy received fewer interventions, likely due to limited joint exposure.
Lack of randomization (observational design)

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Implication

Arthroscopy offers no short-term PRO advantage over arthrotomy during PAO; leaves open need for RCTs on durability and complications.

Abstract

≥ 0.076). Patients treated with PAO and arthrotomy experienced greater mean improvement in two out of the 13 PROs; the other 11 showed no differences. No treatment effect was observed for any of the 13 PROs using multivariable modelling that accounted for severity of dysplasia and degree of arthritis. Few differences were shown in short-term clinical outcomes between HA and arthrotomy at the time of PAO. This work highlights the need for a high quality randomized clinical trial to provide definitive guidance on whether hip preservation surgeons should address intra-articular pathology at the time of PAO for DDH and which technique best serves this purpose.

Discussion

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Cite This Study

Wyles et al. (2018) conducted a cohort in Symptomatic developmental dysplasia of the hip (DDH) (n=71). Hip arthroscopy vs. Open arthrotomy was evaluated on Change in 13 patient-reported outcomes (PROs) at 1 year (p=>=0.061). Hip arthroscopy and open arthrotomy demonstrated similar improvements across 13 patient-reported outcomes at 1 year when performed during periacetabular osteotomy for hip dysplasia.

synapsesocial.com/papers/6a9c580e9718b06d6676dab7 https://doi.org/10.1093/jhps/hny022

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Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Figures

Study Design

Structured PICO

Main Result

Limitations

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Implication

Abstract

Discussion

Cite This Study

Arthroscopy and arthrotomy to address intra-articular pathology during PAO for hip dysplasia demonstrates similar short-term outcomes

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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