Outcomes after hip arthroscopy in hip dysplastic patients previously treated with periacetabular osteotomy. Results from the Danish Hip Arthroscopy Registry
ESSKA Academy. Mygind-Klavsen B. 05/09/18; 212749; P19-986 Topic: E12 - Open periacetabular osteotomy
Dr. Bjarne Mygind-Klavsen
Dr. Bjarne Mygind-Klavsen
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Abstract
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Objectives: Periacetabular osteotomy (PAO) is the standard surgical intervention for dysplasia of the hip. To address postoperative labral and cartilage injury, hip arthroscopy is often performed. However, limited knowledge exists concerning the outcome after arthroscopy. The purpose of this study is to identify outcomes after hip arthroscopy in patients previously treated with PAO and to determine the response rate of clinically relevant improvement. Moreover, the study aims to compare outcome with patients treated with hip arthroscopy for femoral acetabular impingement (FAI).

Methods: 198 patients that underwent hip arthroscopy after PAO were identified through the Danish Hip Arthroscopy Registry (DHAR), a web-based prospective registry. Preoperative clinical evaluation and perioperative data was collected. Preoperatively and 1 and 2-years postoperatively the following outcome scores were assessed: HAGOS, EQ-5D, iHOT12, NRS pain scores at rest and during activity and HSAS. An increase in HAGOS scores >10 point was considered a clinically relevant improvement for response rate determination. The clinical outcomes were compared with a patient cohort of 1835 FAI patients from DHAR.

Results: We included 21 males and 177 females. Mean age was 33 (range 15-62). All HAGOS subscale scores improved significantly: Pain 45 to 61, Symptoms 43 to 54, ADL 50 to 66, Sports 29 to 45, physical activity (PA) 16 to 32 and QOL 25 to 42 respectively. NRS pain improved from 44 at rest and 63 during activity to 30 and 41 respectively. EQ-5D improved from 0.59 preoperatively to 0.70. HSAS improved from 1.9 preoperatively to 2.8.
At 2-year follow-up clinically relevant improvement of >10 points in HAGOS subscale scores were seen in Pain 56%, Symptoms 52%, ADL 46%, Sports 50%, PA 54% and QOL 48%.
At 2-year follow-up PAO patient outcome compared to FAI patients with following scores: HAGOS: Pain 61 compared to 73; Symptoms 54 compared to 69; ADL 66 compared to 75, Sports 45 compared to 60, PA 32 compared to 47 and QOL 42 compared to 56 respectively. EQ-5D was 0.70 compared to 0.78. Mean NRS pain score at rest was 30 compared to 17 and 41 compared to 22 during activity. Student T-test showed that FAI patients experienced a significantly greater improvement compared to PAO patients in HAGOS subscale scores Symptoms and ADL, and in NRS pain during activity. However, Chi2 test comparison of the proportion of patients that experienced > 10 point and < 10 improvement in HAGOS subscale scores showed no significant difference between PAO and FAI patients.

Conclusions: Hip arthroscopy in patients with previously performed PAO improves subjective outcomes. The clinical relevance of this study is that hip arthroscopy after PAO improves self-reported outcomes but to the same degree as FAI patients.

Keywords:
Hip Arthroscopy, Peri Acetabular Osteotomy
Objectives: Periacetabular osteotomy (PAO) is the standard surgical intervention for dysplasia of the hip. To address postoperative labral and cartilage injury, hip arthroscopy is often performed. However, limited knowledge exists concerning the outcome after arthroscopy. The purpose of this study is to identify outcomes after hip arthroscopy in patients previously treated with PAO and to determine the response rate of clinically relevant improvement. Moreover, the study aims to compare outcome with patients treated with hip arthroscopy for femoral acetabular impingement (FAI).

Methods: 198 patients that underwent hip arthroscopy after PAO were identified through the Danish Hip Arthroscopy Registry (DHAR), a web-based prospective registry. Preoperative clinical evaluation and perioperative data was collected. Preoperatively and 1 and 2-years postoperatively the following outcome scores were assessed: HAGOS, EQ-5D, iHOT12, NRS pain scores at rest and during activity and HSAS. An increase in HAGOS scores >10 point was considered a clinically relevant improvement for response rate determination. The clinical outcomes were compared with a patient cohort of 1835 FAI patients from DHAR.

Results: We included 21 males and 177 females. Mean age was 33 (range 15-62). All HAGOS subscale scores improved significantly: Pain 45 to 61, Symptoms 43 to 54, ADL 50 to 66, Sports 29 to 45, physical activity (PA) 16 to 32 and QOL 25 to 42 respectively. NRS pain improved from 44 at rest and 63 during activity to 30 and 41 respectively. EQ-5D improved from 0.59 preoperatively to 0.70. HSAS improved from 1.9 preoperatively to 2.8.
At 2-year follow-up clinically relevant improvement of >10 points in HAGOS subscale scores were seen in Pain 56%, Symptoms 52%, ADL 46%, Sports 50%, PA 54% and QOL 48%.
At 2-year follow-up PAO patient outcome compared to FAI patients with following scores: HAGOS: Pain 61 compared to 73; Symptoms 54 compared to 69; ADL 66 compared to 75, Sports 45 compared to 60, PA 32 compared to 47 and QOL 42 compared to 56 respectively. EQ-5D was 0.70 compared to 0.78. Mean NRS pain score at rest was 30 compared to 17 and 41 compared to 22 during activity. Student T-test showed that FAI patients experienced a significantly greater improvement compared to PAO patients in HAGOS subscale scores Symptoms and ADL, and in NRS pain during activity. However, Chi2 test comparison of the proportion of patients that experienced > 10 point and < 10 improvement in HAGOS subscale scores showed no significant difference between PAO and FAI patients.

Conclusions: Hip arthroscopy in patients with previously performed PAO improves subjective outcomes. The clinical relevance of this study is that hip arthroscopy after PAO improves self-reported outcomes but to the same degree as FAI patients.

Keywords:
Hip Arthroscopy, Peri Acetabular Osteotomy
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