Patient-Reported Outcomes After Periacetabular Osteotomy Versus Hip Arthroscopy for Borderline Acetabular Dysplasia Are Both Favorable: A Systematic Review
Authors: Kuhns BD, Becker N, Strok MJ, O'Brien EJ, Hassan M, Domb BG
DOI: 10.1016/j.arthro.2024.11.090
Journal: Arthroscopy, 2024
Objective
To compare the effectiveness of hip arthroscopy versus periacetabular osteotomy (PAO) in the treatment of borderline hip dysplasia (BHD) using patient-reported outcome measures (PROMs).
Methodology
A systematic review of 26 studies published after 2014—8 focusing on PAO and 18 on arthroscopy. The studies were assessed for radiographic data, intraoperative findings, and PROMs, including mHHS.
Key Findings
- Both surgical options resulted in significant improvement in PROMs for BHD.
- Arthroscopy cohorts often showed greater cam morphology (higher alpha angles), indicating different indications within the BHD spectrum.
- Mean mHHS improvement ranged from 20–29 in PAO studies and 17.9–34.4 in arthroscopy studies.
- Heterogeneity in surgical technique, outcome measures, and patient populations limited direct comparisons.
Conclusion
PAO and hip arthroscopy can both be effective in treating BHD. Surgical selection should be guided by individual patient anatomy and pathology, particularly the presence of cam-type morphology.
What Does This Mean for Providers?
This review highlights that both PAO and arthroscopy are viable options for managing borderline dysplasia, but treatment should be personalized. For patients with structural instability and minimal cam lesions, PAO may be preferred. Conversely, those with mixed or cam-dominant morphology may benefit more from arthroscopy. Providers should integrate radiographic findings, patient symptoms, and intraoperative observations to select the optimal intervention.