Long-term Outcomes of Advanced Arthroscopic Techniques for Patients With Acetabular Retroversion Without Anteverting Periacetabular Osteotomy

Abstract

Background:

Anterolateral acetabular overcoverage, also known as acetabular retroversion, can cause femoroacetabular impingement syndrome (FAIS). Various surgical options have been suggested for treatment, ranging from anteverting periacetabular osteotomy to isolated hip arthroscopy.

Purpose/Hypothesis:

The purpose of this study was, primarily, to analyze minimum 10-year outcomes of arthroscopic management of labral pathology in the setting of acetabular retroversion without dysplasia and, secondarily, to compare their outcomes to a propensity-matched group of nonretroverted patients. It was hypothesized that the outcomes of arthroscopic management would be comparable to those of the propensity-matched nonretroverted group and comparable to previously published outcomes of open treatment of acetabular retroversion.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and December 2013 and had a minimum of 10-year follow-up data. Retroversion was determined based on the presence of an ischial spine sign, >20% crossover sign, and posterior wall sign. Propensity score matching was used to identify a control group without retroversion who were matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment.

Results:

A total of 95 hips with acetabular retroversion were matched to a control group. The groups were equally matched in demographic variables. Significant improvements were seen in all patient-reported outcomes (PROs) collected in both groups, with a similar survivorship of 96% in both groups; 4 patients in each group converted to a total hip replacement. The acetabular retroversion cohort achieved similarly high rates of minimal clinically important difference and Patient Acceptable Symptom State and higher rates of substantial clinical benefit for modified Harris Hip Score compared with the control group (P = .04).

Conclusion:

Patients with acetabular retroversion who had FAIS and labral tears could be safely treated using advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon’s hands. Patients with acetabular retroversion demonstrated favorable PROs and low rates of revision arthroscopy and conversion to total hip arthroplasty at long-term follow-up, which was comparable with a propensity-matched control group without acetabular retroversion.