BACKGROUND Hip arthroscopy in the setting of dysplasia and borderline dysplasia is controversial. Dysplasia severity is most often defined by the lateral center edge angle (LCEA) but can also be evaluated radiographically by the acetabular inclination (AI). PURPOSE/HYPOTHESIS The purpose was to determine the effect of AI on outcomes after isolated hip arthroscopy for femoroacetabular impingement (FAI). We hypothesized that patients with dysplasia would have higher rates of arthroplasty as well as inferior clinical and functional outcomes compared with patients who did not have dysplasia. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A hip arthroscopy registry was reviewed for participants undergoing arthroscopic correction of FAI from February 28, 2008, to June 10, 2013. Participants required a clinical diagnosis and isolated arthroscopic correction of FAI with preoperative imaging and intraoperative cartilage status recorded. AI dysplasia was defined as an AI greater than 10°, LCEA dysplasia as LCEA less than 18°, and borderline LCEA dysplasia as LCEA 18° to 25°. Patients without an acetabular deformity (LCEA 25°-40°; AI <10°) served as a control population. Postoperative variables included patient-reported outcome surveys with conversion to arthroplasty as the primary endpoint. Minimum 5-year outcome scores were obtained for 337 of 419 patients (80.4%) with an average follow-up of 75.2 ± 12.7 months. RESULTS This study included 419 patients: 9 (2%) with LCEA dysplasia, 42 (10%) with AI dysplasia, and 51 (12%) with borderline dysplasia. The AI but not LCEA was significantly correlated with lower outcome scores on the modified Harris Hip Score (r = 0.13; P = .01), Non-Arthritic Hip Score (r = 0.10; P = .04), and Hip Outcome Score-Sports Subscale (r = 0.11; P = .04). A total of 58 patients (14%) underwent arthroplasty at 31 ± 20 months postoperatively. Patients with LCEA dysplasia had an arthroplasty rate of 56% (odds ratio, 8.4), whereas patients with AI dysplasia had an arthroplasty rate of 31% (odds ratio, 3.3), which was significantly greater than the rate for the nondysplastic cohort (13.5%; P < .0001). Patients with borderline LCEA dysplasia did not have increased rates of arthroplasty. A multivariate analysis found increasing age, increasing AI, Tönnis grade higher than 1, and femoral Outerbridge grade higher than 2 to be most predictive of conversion to arthroplasty. CONCLUSION We found that an elevated AI, along with increasing age, Tönnis grade, and femoral Outerbridge grade significantly predict early conversion to arthroplasty after isolated hip arthroscopy. We recommend using the AI, in addition to the LCEA, in evaluating hip dysplasia before hip arthroscopy.

中文翻译：

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髋臼的形态学特征可预测髋臼分离后髋关节置换术后早期转换为髋关节置换术。

背景技术在不典型增生和边缘性不典型增生的背景下的髋关节镜检查是有争议的。发育异常的严重程度通常由侧向中心边缘角（LCEA）定义，但也可以通过髋臼倾斜度（AI）进行影像学评估。目的/假设目的是确定人工髋关节镜检查对股骨髋臼撞击（FAI）后AI对预后的影响。我们假设与不典型增生的患者相比，不典型增生的患者的置换术率更高，临床和功能结局也较差。研究设计队列研究；证据等级，3。方法对接受关节镜矫正FAI的参与者从2008年2月28日至2013年6月10日进行的髋关节镜注册进行了审查。参与者需要进行FAI的临床诊断和关节镜矫正，并记录术前影像和术中软骨状态。AI不典型增生定义为AI大于10°，LCEA不典型增生定义为LCEA小于18°，临界LCEA不典型增生定义为LCEA 18°至25°。没有髋臼畸形（LCEA 25°-40°； AI <10°）的患者作为对照组。术后变量包括患者报告的结局调查，其中以关节置换术为主要终点。在419例患者中有337例（50.4％）获得了最低5年结局评分，平均随访75.2±12.7个月。结果该研究包括419例患者：9例（2％）LCEA发育异常，42例（10％）AI发育异常和51例（12％）边缘性发育不良。AI（而非LCEA）与改良后的Harris髋关节得分（r = 0.13； P = .01），非田径髋关节得分（r = 0.10； P = .04）和髋关节成绩得分较低的结局得分显着相关。运动分量表（r = 0.11; P = .04）。共有58例患者（14％）在术后31±20个月接受了置换术。LCEA异型增生患者的置换率为56％（奇数比，8.4），而AI异型增生患者的置换率为31％（奇数比，3.3），显着高于非增生性队列（13.5） ％; P <.0001）。LCEA边缘性不典型增生的患者的置换率没有增加。一项多变量分析发现，年龄增长，AI增加，Tönnis评分高于1，股外桥评分高于2可以最有效地预测关节置换术的转化。结论我们发现，随着年龄，Tönnis等级和股外桥等级的升高，AI升高将显着预测孤立型髋关节镜检查后早期向关节成形术的转化。我们建议除了LCEA外，还应使用AI来评估髋关节镜检查之前的髋关节发育不良。