Factors Associated With Return to Sport at Minimum 10-Year Follow-up in Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication.

Abstract

Background: Literature on long-term return-to-sport (RTS) rates in athletes with borderline hip dysplasia (BHD) is limited.

Purpose: To examine patient outcomes and RTS rates in athletes with BHD who underwent primary hip arthroscopy with capsular plication at a minimum 10-year follow-up.

Study design: Cohort study; Level of evidence, 3.

Methods: Data were retrospectively reviewed for all patients with BHD (lateral center-edge angle 18°-25°) who underwent primary hip arthroscopy with labral treatment and capsular plication between September 2008 and May 2014. Athletes in the BHD group were propensity matched 1:1 to a control group of patients with normal acetabular coverage based on age, sex, body mass index, follow-up time, Tönnis grade, and preoperative sport competition level. Patient-reported outcome scores (modified Harris Hip Score, Non-Arthritic Hip Score, 12-item International Hip Outcome Tool, Hip Outcome Score Sports Specific Subscale, visual analog scale for pain, and satisfaction), RTS, and continuation-of-sport rates were also analyzed.

Results: There were 50 patients (53 hips) in the BHD group and 53 patients (53 hips) in the control group. Both groups demonstrated similar increases in all PROs from preoperative to 10-year follow-up and favorable RTS rates. A total of 46 patients in the BHD group attempted to RTS and 40 (87.0%) were successful while 48 patients in the control group attempted to RTS and 41 (85.4%) were successful at the short to midterm. Of the patients who successfully returned to sport, 28 from the BHD cohort (70.0%) and 30 (73.2%) from the control cohort attempted to continue playing their respective sport 10 years postoperatively. Of these, 23 patients (82.1%) from the BHD cohort and 25 patients (83.3%) from the control cohort successfully continued their sport at a minimum of 10 years postoperatively. Over the course of 10 years of follow-up, 8 patients (16%) out of 50 in the BHD group at some point discontinued their sport, not due to their hip, but because of lifestyle changes or loss of interest.

Conclusion: Athletes with BHD who underwent primary hip arthroscopy with capsular plication and labral treatment demonstrated a high rate of RTS at short-term follow-up, high rate of continuation of sport at long-term follow-up, and favorable long-term results. Loss of interest or lifestyle transitions had a greater impact on continuation of sport at long-term follow-up than persistent symptoms related to the hip.