Adult dysplasia of the hip; the role of labral pathology and effect of pelvic tilt.

Labral pathology is seen in both dysplastic and borderline dysplastic hips. Periacetabular osteotomy (PAO) is the treatment of choice for dysplasia. However, some authors have suggested that borderline dysplastic hips with concurrent labral pathology should be treated arthroscopically. The purpose of this study was to investigate the frequency of labral pathology between dysplastic and borderline dysplastic hips, whether center-edge (CE) angle is associated with labral pathology, and finally if pain and labral pathology are associated.
99 symptomatic patients (104 hips) scheduled for PAO were examined. Five patients were excluded due to complaints from multiple joints and 4 failed to show at 2-year follow-up. 5 patients did not fill out questionnaires pre-operatively. Hips were characterized as dysplastic (CE angle<200) and borderline dysplastic (CE angle 200≤250). A Magnetic Resonance Arthrography was performed labral pathology was classified according to the Czerny classification. Association with the CE angle, the acetabular index and preoperative WOMAC pain score was tested by multiple linear regression.
There was no significant difference in frequency of labral pathology when comparing the two groups. Across the cohort, 86 of 99 patients had labral pathology. The CE angle was associated with increasing severity of labral pathology whereas the AI angle and preoperative pain were not associated with labral pathology.
Decreased lateral coverage adversely loads the labrum, predisposing it to tears. We advocate reorienting the biomechanical forces through PAO, not arthroscopic treatment. Level of pain was not associated with labral pathology, suggesting that labral pathology may not alone explain the dysplastic pain complex.