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
DOI: 10.1016/j.arthro.2025.02.032
Background
Borderline hip dysplasia (BHD) involves both hip instability and femoroacetabular impingement (FAI), complicating treatment choices. While periacetabular osteotomy (PAO) addresses bony instability, hip arthroscopy (HA) with capsular plication offers a less invasive alternative. This study compares outcomes of combined PAO + HA versus isolated HA in BHD patients.
Methods
Retrospective comparative study of 74 patients with FAI and BHD undergoing either staged PAO with arthroscopy (PAO group) or isolated arthroscopy with capsular plication (HA group). Groups matched 1:1 by age, sex, BMI, and Tönnis grade. Outcomes assessed with multiple PROs at minimum 2-year follow-up.
Key Findings
- Both groups had similarly favorable PROs:
- mHHS ~90
- NAHS ~89–91
- HOS-SSS ~81–82
- VAS pain ~1.5–1.7
- Rates of achieving MCID, PASS, and MOI were comparable between groups.
- Complication rates were low and not significantly different (10.8% PAO vs. 5.4% HA, p = 0.67).
- Revision and conversion to arthroplasty rates were similar at 2 years.
Conclusion
Both staged PAO with arthroscopy and isolated hip arthroscopy with capsular plication provide effective treatment options for borderline hip dysplasia, yielding comparable clinical improvements and low complication rates at 2 years.
What Does This Mean For Providers?
- Surgeons have two viable surgical strategies for borderline dysplasia, allowing individualized treatment plans based on patient anatomy, symptoms, and goals.
- PAO + HA may better address bony instability in select patients, while isolated HA with capsular plication offers a less invasive option.
- Comparable outcomes and complication rates suggest both approaches can be considered safe and effective.
- Providers should weigh patient-specific factors such as severity of instability, surgical risk tolerance, and recovery preferences when recommending treatment.
- These findings support shared decision-making and realistic patient counseling regarding the pros and cons of each approach.