Editorial Commentary: Arthroscopic Treatment of Mild Hip Dysplasia Can Result in Excellent Outcome and Avoid More Invasive Periacetabular Osteotomy
Authors: Domb BG, Wallace IA, Becker N
DOI: 10.1016/j.arthro.2024.10.023
Journal: Arthroscopy, 2025
Objective
To provide expert commentary on the role of hip arthroscopy in treating mild dysplasia, potentially delaying or avoiding more invasive surgeries like periacetabular osteotomy (PAO).
Methodology
A literature-based editorial synthesizing clinical experience and published outcomes to support the use of arthroscopy in managing mild dysplasia.
Key Findings
- Arthroscopy can address labral tears, capsular laxity, and cam deformities often present in patients with mild dysplasia.
- In carefully selected patients, instability due to soft tissue pathology can be managed effectively without PAO.
- PAO remains appropriate for moderate-to-severe dysplasia or persistent instability.
Conclusion
Hip arthroscopy offers a minimally invasive, joint-preserving option for patients with mild dysplasia. When applied appropriately, it can delay or negate the need for PAO, providing excellent outcomes with reduced morbidity.
What Does This Mean for Providers?
Surgeons treating borderline or mild dysplasia should consider arthroscopy in well-selected cases, particularly when symptoms arise from soft tissue insufficiency rather than structural instability. Capsular plication and labral preservation or repair are critical to maintaining hip stability. Arthroscopy should be viewed as part of a treatment continuum, not a replacement for PAO in more severe deformities. Shared decision-making and advanced imaging are essential to optimize patient selection.