It has been reported that 60-85% of patients who undergo PAO have concomitant intraarticular pathology that cannot be addressed with PAO alone. Currently, there are limited diagnostic tools to determine which patients would benefit from hip arthroscopy at the time of PAO to address intra-articular pathology. This study aims to see if preoperative PROMs scores measured by IHOT-33 scores have predictive value in whether intra-articular pathology is addressed during PAO + scope. The secondary aim is to see how often surgeons at high-volume hip preservation centers address intra-articular pathology if a scope is performed during the same anesthesia event.

A randomized, prospective Multicenter trial was performed on patients who underwent PAO and hip arthroscopy to treat hip dysplasia from 2019 to 2020. Preoperative PROMs and intraoperative findings and procedures were recorded and analyzed. A total of 75 patients, 84% Female, and 16% male, with an average age of 27 years old, were included in the study. Patients were randomized to have PAO alone 34 patients vs. PAO + arthroscopy 41 patients during the same anesthesia event. The procedures performed, including types of labral procedures and chondroplasty procedures, were recorded. Additionally, a two-sided student T-test was used to evaluate the difference in means of preoperative IHOT score among patients for whom a labral procedure was performed versus no labral procedure.

A total of 82% of patients had an intra-articular procedure performed at the time of hip arthroscopy. 68% of patients who had PAO + arthroscopy had a labral procedure performed. The most common labral procedure was a labral refixation which was performed in 78% of patients who had a labral procedure performed. Femoral head-neck junction chondroplasty was performed in 51% of patients who had an intra-articular procedure performed. The mean IHOT score was 29.3 in patients who had a labral procedure performed and 33.63 in those who did not have a labral procedure performed P- value=0.24.

Our findings demonstrate preoperative IHOT-33 scores were not predictive in determining whether intra-articular labral pathology was addressed at the time of surgery. Additionally, we found that if labral pathology was addressed, labral refixation was the most common repair performed. This study also provides valuable information on what procedures high-volume hip preservation centers are performing when performing PAO + arthroscopy.

Background

Supine positioning during direct anterior approach total hip arthroplasty (DAA THA) facilitates use of fluoroscopy, which has been shown to improve acetabular component positioning on plane radiograph. This study aims to compare 2- dimensional intraoperative radiographic measurements of acetabular component position with RadLink to postoperative 3- dimensional SterEOS measurements.

INTRODUCTION:

The senior surgeon has performed THA in his practice for over 30 years, and, while performing THA and revision THA utilizing a variety of surgical approaches, has employed and taught the modified Gibson posterolateral approach to the hip joint as his “workhorse” surgical approach for the majority of his career. In following the development of the DAA, he felt that there were subgroups of patients in his practice for whom the DAA, and supine THA, might prove beneficial, and started to introduce this approach into his practice 2 years ago. This retrospective review describes the risks and benefits of choosing to introduce this approach, and outlines a rational way in which surgeons can decide if they should learn and then offer this approach to appropriate patients within their practice.