Editorial Commentary: Evaluate for the Beighton Score and Additional Radiographic Signs of Instability Prior to Proceeding With Hip Arthroscopy in Patients With Combined Borderline Hip Dysplasia and Excessive Femoral Anteversion

Editorial Commentary: Evaluate for the Beighton Score and Additional Radiographic Signs of Instability Prior to Proceeding With Hip Arthroscopy in Patients With Combined Borderline Hip Dysplasia and Excessive Femoral Anteversion

Authors: Curley AJ, Domb BG

Journal: Arthroscopy, April 2023

DOI: 10.1016/j.arthro.2022.12.001

Objective

Discuss the importance of assessing the Beighton Score and radiographic signs of instability before hip arthroscopy in patients with borderline hip dysplasia (BHD) combined with excessive femoral anteversion (EFA).

Key Findings

• EFA (>20°) can cause or worsen hip instability, especially when combined with BHD.
• Differentiating femoroacetabular impingement (FAI) symptoms from instability is critical for appropriate treatment.
• Radiographic parameters such as Tönnis angle, coxa valga, and acetabular coverage are important for comprehensive evaluation.
• Isolated hip arthroscopy may be insufficient; more extensive procedures like periacetabular osteotomy may be required.

Conclusion

Comprehensive instability evaluation, including Beighton Score and radiographic assessment, is essential before hip arthroscopy in patients with combined BHD and EFA to avoid suboptimal outcomes.

What Does This Mean for Providers?

• Incorporate clinical hypermobility assessment (Beighton Score) and detailed radiographic analysis in preoperative planning.
• Recognize the complexity of combined BHD and EFA when considering surgical options.
• Avoid isolated arthroscopy if instability is evident; consider referral for or combined procedures such as periacetabular osteotomy.
• Tailor patient counseling regarding realistic outcomes and potential surgical approaches.