Background:Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort.Purpose:To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort.Study Design:Systematic review; Level of evidence, 4.Methods:A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated outcomes of primary hip arthroscopy in patients with lateral center-edge angle (LCEA) <25° at ≥5-year follow-up. Risk of bias assessment was performed using the methodological index for non-randomized studies scoring system. Level of evidence was determined using criteria from the Oxford Centre for Evidence-Based Medicine.Results:Nine studies were included in this review. Patients with LCEA <25° demonstrated satisfactory clinical outcomes, high patient satisfaction, and significant postoperative improvements in patient-reported outcomes (PROs) at follow-up ranging from a ≥5 to 10 years. Studies comparing patients with dysplasia to those without did not demonstrate significant differences in preoperative, postoperative, or delta PROs or in failure, reoperation, or revision rates. There was no overall significant correlation between outcomes and LCEA stratification.Conclusion:Hip arthroscopy in carefully selected patients with LCEA <25° can be successful at mid- to long-term follow-up and may provide clinical outcomes and failure rates comparable with patients with normal LCEA, understanding that this is a singular, 2-dimensional radiographic measure that does not differentiate instability from impingement or combinations thereof, warranting future studies delineating these differences. These findings suggest that hip dysplasia may not be an absolute contraindication for isolated hip arthroscopy and may serve as a viable intervention with consideration of staged future periacetabular osteotomy (PAO). Importantly, this review does not suggest that hip arthroscopy alters the natural history of dysplasia; therefore, patients with dysplasia should be counseled on the potential utility of PAO by appropriate hip preservation specialists.

中文翻译：

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髋臼发育不良患者初次髋关节镜检查：对已发表的至少 5 年随访临床结果的系统评价

背景：髋关节镜检查治疗交界性髋关节发育不良患者短期随访效果满意；然而，中期结果的数据不一致，并且一些研究中的失败率很高，限制了对髋关节镜在该患者队列中的作用和效用的理解。 目的：提供最新的、基于证据的审查随访 5 年以上的明显或边缘性髋关节发育不良患者初次髋关节镜检查的临床结果，并报告该队列中的失败率和全髋关节置换术的进展。证据水平，4.方法：根据PRISMA（系统评价和荟萃分析的首选报告项目）指南进行全面的文献检索。如果研究在≥5年的随访中评估了横向中心边缘角（LCEA）<25°的患者初次髋关节镜检查的结果，则纳入研究。使用非随机研究评分系统的方法学指数进行偏倚风险评估。证据水平是根据牛津循证医学中心的标准确定的。结果：本次评价纳入了九项研究。LCEA <25° 的患者表现出令人满意的临床结果、较高的患者满意度以及在 ≥5 至 10 年的随访中患者报告结果 (PRO) 的术后显着改善。对不典型增生患者与不典型增生患者进行比较的研究并未显示出术前、术后或 Delta PRO 或失败、再次手术或翻修率方面存在显着差异。结果与 LCEA 分层之间不存在总体显着相关性。结论：精心挑选的 LCEA <25° 患者的髋关节镜检查可以在中长期随访中取得成功，并且可以提供与 LCEA <25° 患者相当的临床结果和失败率。正常 LCEA，了解这是一种单一的二维射线照相测量，无法区分不稳定性和撞击或其组合，因此有必要进行未来的研究来描述这些差异。这些发现表明，髋关节发育不良可能不是孤立髋关节镜检查的绝对禁忌症，并且可以作为考虑未来分阶段髋臼周围截骨术（PAO）的可行干预措施。重要的是，本次综述并不表明髋关节镜检查会改变发育不良的自然史。因此，髋关节保护专家应就 PAO 的潜在效用向发育不良患者提供咨询。