Arthroscopic partial limbectomy in hip joints with acetabular hypoplasia.

PURPOSE

The purpose of this study was to clarify whether arthroscopic partial excision of a torn labrum in acetabular hypoplasia leads to rapid progression of osteoarthritis.

TYPE OF STUDY

Clinical case study.

MATERIALS AND METHODS

We performed arthroscopic partial limbectomy in 10 hips with pre- or early osteoarthritis secondary to acetabular hypoplasia. All the patients were females with mechanical symptoms such as giving way, catching, locking, or clicking sound. Their ages at the time of surgery ranged from 14 to 62 years (mean, 33.7 y). The follow-up period ranged from 2 to 14 years (mean, 8 y). None of the hips had subluxation. Arthroscopic surgery was performed in the supine position on a traction table, using a simultaneous 3-directional approach. The preoperative center-edge (CE) angle ranged from 0 degrees to 20 degrees (mean, 12.4 degrees).

RESULTS

In all patients, preoperative radiographs and magnetic resonance imaging (MRI) depicted no tear of the acetabular labrum, whereas arthroscopic examinations revealed tears incarcerated in the joint space. Coxalgia improved within 4 or 5 days after surgery in all patients, showing that the torn labrum had caused the pain. The tears were classified as bucket-handle type in 6 hips, degenerative type in 3 hips, and flap type in 1 hip. Mechanical symptoms had subsided or disappeared in all hips postoperatively for a mean follow-up of 8 years. Radiographs revealed no evidence of osteoarthritis progression, although one case with a preoperative CE angle of 0 degrees showed lateralization of the femoral head.

CONCLUSIONS

Labral tears in acetabular hypoplasia or dysplastic hip are mostly the bucket-handle type, located at the anterosuperior part of the acetabulum. Incarceration of the torn labrum in the joint space causes coxalgia. Rapid progression of osteoarthritis after limbectomy was not observed up to 8 years after surgery in this series.

LEVEL OF EVIDENCE

Level IV.