Murata Yoichi, Fukase Naomasa, Martin Maitland, Soares Rui, Pierpoint Lauren, Dornan Grant J, Uchida Soshi, Philippon Marc J
Steadman Philippon Research Institute and The Steadman Clinic, Vail, Colorado, USA.
Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan.
Orthop J Sports Med. 2021 May 4;9(5):23259671211007401. doi: 10.1177/23259671211007401. eCollection 2021 May.
The treatment for borderline developmental dysplasia of the hip (BDDH) has historically been arthroscopic surgery or periacetabular osteotomy (PAO). As orthopaedic surgery is constantly evolving, a lack of comparison of outcomes for these 2 treatment methods could potentially be stalling the progression of treatment for patients with BDDH.
To evaluate the existing literature on patient characteristics, procedures, clinical outcomes, and failure rates for patients with BDDH and to determine whether PAO or hip arthroscopic surgery is a better treatment method for patients with BDDH.
Systematic review; Level of evidence, 4.
Studies included were found using the following search words: "hip" and "borderline dysplasia," "osteotomy" or "arthroscopy," and "outcome" or "procedure." Articles were included if they detailed participants of all sexes and ages, reported on isolated hips, and had patients diagnosed with BDDH.
A search was conducted across 3 databases, resulting in 469 articles for consideration, from which 12 total studies (10 on arthroscopic surgery and 2 on PAO) were chosen for a review. There were 6 studies that included patients with a lateral center-edge angle of 18° to 25°, while the remainder included patients with a lateral center-edge angle of 20° to 25°. All the studies reviewing arthroscopic surgery reported concomitant/accessory procedures, while the articles on the topic of PAO did not. It was determined that, whether treated using arthroscopic surgery or PAO, outcomes improved across all patient-reported outcome measures. Revision surgery was also common in both procedures.
There is a lack of consensus in the literature on the best treatment option for patients with BDDH. Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes.
髋关节边缘性发育不良（BDDH）的治疗方法在历史上一直是关节镜手术或髋臼周围截骨术（PAO）。随着骨科手术不断发展，缺乏对这两种治疗方法疗效的比较可能会阻碍BDDH患者治疗的进展。
评估关于BDDH患者的患者特征、手术方法、临床疗效和失败率的现有文献，并确定PAO或髋关节镜手术对于BDDH患者而言哪种是更好的治疗方法。
系统评价；证据等级，4级。
使用以下检索词查找纳入研究：“髋关节”和“边缘性发育不良”、“截骨术”或“关节镜检查”、“疗效”或“手术”。如果文章详细描述了所有性别和年龄的参与者、报告了单髋情况且患者被诊断为BDDH，则纳入。
在3个数据库中进行了检索，共筛选出469篇文章以供考虑，从中选取了12项研究（10项关于关节镜手术，2项关于PAO）进行综述。6项研究纳入了外侧中心边缘角为18°至25°的患者，其余研究纳入了外侧中心边缘角为20°至25°的患者。所有关于关节镜手术的研究均报告了伴随/辅助手术，而关于PAO主题的文章未提及。结果发现，无论采用关节镜手术还是PAO治疗，所有患者报告的疗效指标均有所改善。翻修手术在两种手术中也很常见。
文献中对于BDDH患者的最佳治疗选择缺乏共识。在评估哪种手术方法能带来最有利的疗效时，应考虑术前患者特征和伴随损伤情况。
