Hip arthroscopy after previous acetabular osteotomy for developmental dysplasia of the hip

Purpose: The purpose of this study was to examine the arthroscopic findings in the hips of patients with long-term follow-up of Chiari osteotomies. Type of Study: Prospective consecutive series of patients. Methods: Seven consecutive patients (1 male, 6 female; average age, 23 years) having a Chiari osteotomy performed in 1 hip during childhood or adolescence for developmental dysplasia of the hip were studied. They presented mechanical hip symptoms and had adequate head coverage as a result of the osteotomy with preservation of joint space. Hip arthroscopy was performed in all cases. Results: A massive labral tear dislocated in the midportion of the joint was found in all cases with varying degrees of cartilage damage in the acetabulum or femoral head. The labral tear was resected, cartilage lesions were repaired, and microfracturing of the exposed subchondral bone was performed. Mechanical symptoms improved after surgery and all of the patients were able to go back to activities of daily living. Conclusions: In the Chiari osteotomy, medial displacement of the acetabulum leaves the labrum in the center of the load-bearing area of the resulting acetabulum. Over time this can produce a tear of the labrum, which may be the cause of the mechanical symptoms in our series. It has been documented that labral tears can lead to early degenerative hip disease and, combined with the cartilage lesions, may explain in part the long-term bad results of the Chiari osteotomy. Level of Evidence: Level IV.