Return to Sport and Outcomes After Periacetabular Osteotomy With Concomitant Hip Arthroscopy in Athletes: Minimum 5-Year Follow-up
Author(s):Quesada-Jimenez R, Strok MJ, Schab AR, Becker N, Kahana-Rojkind AH, Domb BG.
DOI Link: 10.1177/03635465251391182
Background
Symptomatic acetabular dysplasia in athletes is increasingly managed with combined periacetabular osteotomy (PAO) and hip arthroscopy. While short- and midterm outcomes are established, long-term return-to-sport (RTS) and durability data in athletic populations remain limited.
Methods
This Level IV case series retrospectively reviewed athletes undergoing PAO with concomitant hip arthroscopy between 2010 and 2018. Inclusion required sports participation preoperatively and at least 5-year follow-up with patient-reported outcomes (mHHS, NAHS, HOS-SSS, iHOT-12, VAS, satisfaction) or documented endpoint. Outcomes included PRO improvement, achievement of clinically relevant thresholds (MCID/PASS), RTS rates, sport continuation at ≥5 years, revision arthroscopy, and conversion to THA.
Key Findings
A total of 28 patients (29 hips) were included.
Significant improvements were observed across all PROs with high patient satisfaction. High rates of MCID and PASS achievement were reported across outcome measures.
Return-to-sport outcomes:
- 7% of athletes returned to sport after surgery
- 8% of those who returned were still participating at ≥5 years
- Non-return was primarily due to persistent symptoms or personal/lifestyle decisions
Secondary procedures:
- Revision hip arthroscopy: 13.8%
- Conversion to THA: 3.4%
Conclusion
PAO combined with hip arthroscopy in athletes with dysplasia yields significant and durable improvements in function with high long-term return-to-sport rates and relatively low conversion to arthroplasty at 5-year follow-up.
What Does This Mean for Providers?
Combined PAO and arthroscopy is a viable joint-preserving option in athletic patients with symptomatic dysplasia, offering strong long-term functional outcomes and high likelihood of RTS. Providers should counsel patients that while most athletes return to sport and maintain participation long term, a meaningful minority may require revision procedures or may not return due to persistent symptoms.