Summary

Periacetabular osteotomy with concomitant hip arthroscopy and isolated hip arthroscopy with capsular plication in the setting of borderline hip dysplasia yielded favorable functional outcomes.

Abstract

Background

Traditionally, patients with symptomatic borderline hip dysplasia (BHD) have been managed using periacetabular osteotomy (PAO) with or without concomitant hip arthroscopy. Isolated hip arthroscopy with capsular plication has emerged as a less invasive procedure for restoring hip stability. The purpose of this study is to compare minimum 2-year outcomes of PAO concomitant with hip arthroscopy versus isolated hip arthroscopy with capsular plication, in patients with BHD.

Methods

Data was prospectively collected between 2008 and 2021 and retrospectively reviewed for all patients who underwent surgical intervention for hip pain in the setting of BHD. Patients were included if they had preoperative and minimum 2-year postoperative patient reported outcomes (PROs) or reached an endpoint during the study period. Patients were excluded from this study if they had previous ipsilateral hip pathology, LCEA < 18° or >25°, or preoperative Tonnis osteoarthritis grade > 1. Patients were divided into groups based on whether they underwent concomitant PAO. Patients were propensity matched in a 1:1 ratio based on age, sex, BMI, and Tonnis Grade. Patient characteristics, radiographic measurements, and PROs were reported and compared between the groups.

Results

A total of 74 hips were included in the study. The groups had similar preoperative and minimum two-year postoperative values, and comparable magnitudes of improvement across all PROs. Furthermore, the groups met clinically relevant thresholds at similar rates (p > 0.05). Two patients in the HA group required PAO. The two groups had similar rates of revision surgery (p > 0.05). Complication rates were similar between the groups (p > 0.05).

Conclusion

PAO with concomitant hip arthroscopy and isolated hip arthroscopy with capsular plication in the setting of BHD yielded favorable functional outcomes. A high percentage of patients reached clinically relevant hip preservation thresholds, with similar rates of revision surgery and conversion to arthroplasty at a minimum 2-year follow-up.