The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy: arthroscopy versus arthrotomy
Purpose: Periacetabular osteotomy (PAO) has become an accepted treatment option for patients with severe hip dysplasia. In addition to correcting acetabular architecture, consideration has been given to concomitant joint evaluation and treatment of coexisting intra-articular pathologic conditions, which can be identified with hip arthroscopy or through an open arthrotomy. The purpose of this systematic review was to evaluate the prevalence of intra-articular pathologic conditions identified arthroscopically compared with that of those identified with open arthrotomy.
Methods: A systematic review of the literature was performed by a search of PubMed using the words "periacetabular osteotomy," "Bernese osteotomy," and "Ganz osteotomy." Two reviewers searched for relevant articles that met established inclusion criteria, which follow: (1) they were in the English language, (2) they contained data on patients who underwent periacetabular osteotomy, (3) the study patients underwent concomitant arthroscopy or arthrotomy, and (4) the studies contained data on the intra-articular findings at the time of osteotomy. Exclusion criteria included review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data.
Results: After review of 361 references and abstracts, 8 articles met the inclusion criteria. A total of 775 patients who had undergone PAO were included in the 8 articles. Three articles inspected all joints at the time of PAO and accounted for 345 PAOs. Arthrotomy was used to evaluate 151 hips, and 31 (21%) labral tears were identified. Arthroscopy was used to evaluate 194 hips, and 162 (84%) labral tears were identified. The difference in prevalence is statistically significant (P < .05). Two of the 3 articles reported chondral injury: 141 (73%) acetabular chondral injuries and 52 (27%) femoral chondral injuries were noted in 194 hips.
Conclusions: The prevalence of intra-articular damage, including labral injuries and pathologic conditions of cartilage, at the time of PAO is substantial. Labral tears and chondral injury appear to be better recognized with concomitant arthroscopy when compared with arthrotomy at the time of PAO. Further study is needed to determine whether the treatment of chondrolabral injuries can improve patient outcome and reduce reoperations.