Concomitant Peri-Acetabular Osteotomy and Arthroscopy Versus Isolated Arthroscopy With Capsular Plication for Borderline Dysplasia: Two Good Options
Authors
Quesada-Jimenez R, Schab AR, Cohen MF, Kuhns BD, Kahana-Rojkind AH, Domb BG
Background
Borderline hip dysplasia (BHD) presents a unique challenge in surgical decision-making, as both hip instability and femoroacetabular impingement (FAI) may coexist. While periacetabular osteotomy (PAO) addresses bony instability, hip arthroscopy (HA) with capsular plication offers a less invasive option. This study compared outcomes of concomitant PAO + HA versus isolated HA in patients with BHD.
Methods
This retrospective comparative study evaluated 74 patients who underwent surgery for FAI in the context of BHD between 2008 and 2021. Patients were divided into two groups:
- PAO group: staged PAO with arthroscopy
- HA group: isolated arthroscopy with capsular plication
Patients were matched 1:1 by age, sex, BMI, and Tönnis grade. Outcomes were assessed using multiple patient-reported outcome (PRO) scores at a minimum 2-year follow-up.
Key Findings
- Both groups showed favorable and comparable PROs:
- mHHS ~90
- NAHS ~89–91
- HOS-SSS ~81–82
- VAS pain ~1.5–1.7
- Rates of achieving minimal clinically important difference (MCID) were similar in both groups for all scores.
- PASS and maximal outcome improvement (MOI) rates were also comparable between groups.
- Complication rates were low and not significantly different (10.81% PAO vs. 5.41% HA, p = 0.67).
- Revision and conversion to arthroplasty were similar at 2-year follow-up.
Conclusion
Both PAO with arthroscopy and isolated hip arthroscopy with capsular plication are effective treatment options for patients with borderline hip dysplasia. Each approach led to high rates of clinical improvement with no significant difference in outcomes or complication rates at 2 years.
What Does This Mean For Patients
Patients with borderline dysplasia have two strong surgical options that can lead to meaningful pain relief and improved function. Whether treated with a combination of bone-reshaping and arthroscopy or with a less invasive arthroscopic approach alone, most patients can expect good outcomes.