Hip shelf acetabuloplasty in borderline dysplasia, an alternative between Periacetabular Osteotomy and arthroscopic procedures.

IF 2 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2025-01-01 Epub Date: 2024-10-22 DOI:10.1007/s00264-024-06352-9

Girardot Guillaume, Gedouin Jean-Emmanuel, Baulot Emmanuel, Martz Pierre

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Abstract

Purpose: Surgical treatments for symptomatic borderline dysplastic hips (Lateral Center-Edge Angle: LCEA 18-25°) remain challenging, instability being the primary issue. Currently, treatment options include arthroscopic procedures or peri-acetabular osteotomy (PAO). Although the popularity of the acetabular shelf bone block has declined in favor of PAO, it may still be relevant as a hip joint stabilizer and coverage area, rather than for increasing coverage area by cartilage. We analyzed clinical and radiographic outcomes of 23 borderline hips after undergoing shelf procedure with a minimum follow-up of two years.

Methods: This is a retrospective descriptive study. Clinical evaluations (modified Harris Hip Score: mHHS, Non-Arthritic Hip Score: NAHS, International Hip Outcome Tool: iHOT12) and radiographic assessments were performed before and after surgery. We collected data on revision surgery rates, associated surgical procedures (labrum, impingement), complications, arthrosis progression, and conversion to total hip replacement (THR).

Results: The mean LCEA was 21°, and the mean follow-up period was five years (2 to 14 years). Clinical scores showed significant improvement at the last follow-up, mHHS increasing from 47 to 72 (p < 0.001), NAHS from 42 to 68 (p < 0.001), iHOT12 from 28 to 52 (p < 0.001), and pain levels decreasing from 7 to 3. Revision surgery rate was 13%, and complication rate was 8%. No osteoarthritis beyond Tönnis grade 2, and no cases required conversion to THR.

Conclusion: Arthroscopic procedures and PAO have shown promising results in the treatment of borderline hips. The hip shelf procedure appears to be a simple and effective treatment for stabilizing borderline hips, with favorable outcomes for 80% of patients and a low rate of arthritic progression. Shelf procedure could be a valuable addition to the therapeutic options for painful borderline dysplasia of the hip.

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边缘发育不良的髋关节架髋臼成形术，髋臼周围骨切除术和关节镜手术的替代方案。

目的：对有症状的边缘发育不良髋关节（外侧中心-边缘角度：LCEA 18-25°）的手术治疗仍具有挑战性，不稳定性是主要问题。目前，治疗方法包括关节镜手术或髋臼周围截骨术（PAO）。虽然髋臼骨架骨块的受欢迎程度已经下降，而PAO则更受欢迎，但它作为髋关节稳定器和覆盖区，而不是增加软骨覆盖区，可能仍然具有相关性。我们分析了 23 例接受髋臼骨架术后至少随访两年的边缘髋的临床和影像学结果：这是一项回顾性描述性研究。临床评估（改良哈里斯髋关节评分：mHHS、非关节炎性髋关节评分：NAHS、国际髋关节结果评分：International Hip Outcome Score）：NAHS、国际髋关节结果工具：iHOT12）和放射学评估。我们收集了有关翻修手术率、相关手术程序（髋臼唇、撞击）、并发症、关节病进展以及转为全髋关节置换术（THR）的数据：平均LCEA为21°，平均随访时间为5年（2至14年）。在最后一次随访中，临床评分有了明显改善，mHHS 从 47 分上升到 72 分（p 结论：髋关节镜手术和 PAO 均可改善髋关节功能：关节镜手术和 PAO 在治疗边缘髋关节方面取得了良好的效果。髋关节置架术似乎是稳定边缘髋的一种简单而有效的治疗方法，80%的患者疗效良好，关节炎进展率低。髋关节置架术可作为疼痛性边缘性髋关节发育不良治疗方案的重要补充。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.