EP1.11 Hip Arthroscopy versus combined Hip Arthroscopy and Periacetabular Osteotomy for borderline dysplasia - a comparative study
Abstract
Abstract Background Optimal treatment for borderline hip dysplasia (BLD) remains debated, with options including hip arthroscopy (HA) alone, periacetabular osteotomy (PAO) alone, or combined HA+PAO. This study compared clinical outcomes between HA alone and combined HA+PAO to inform treatment decisions in BLD patients. Methods A retrospective review of BLD patients (lateral central edge angle [LCEA] 18-25°) who underwent either successful HA or combined HA+PAO by a single surgeon at one academic institution. The primary outcome was the International Hip Outcome Tool-12 (iHOT-12) at a minimum 2-year follow-up. Secondary outcomes included achievement of Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) for iHOT-12. Demographics (age, sex, BMI), Beighton laxity score, and radiographic parameters (LCEA, Sourcil angle, femoral torsion, acetabular version) were assessed for baseline comparability. Statistical significance was set at p<0.05. Results A total of 155 hips (48 HA, 107 HA+PAO) were included. Baseline demographics and radiographic parameters were comparable between groups (p>0.05), except for the Beighton laxity score (HA: 1.6 vs. HA+PAO: 4.0, p<0.01), indicating greater hypermobility in the combined group. Both groups demonstrated significant mean iHOT-12 improvement at 2 years (HA: 48.8 to 71.3; HA+PAO: 41.5 to 83.9; p<0.001 for both). Notably, the combined HA+PAO group showed greater improvement (Δ42.4 vs. Δ22.5 for HA alone). A higher proportion of HA+PAO patients achieved iHOT-12 MCID (81% vs. 66%, p=0.03) and PASS (83% vs. 69%, p=0.03). Conclusion Combined hip arthroscopy and periacetabular osteotomy yields superior clinical outcomes and patient satisfaction compared to hip arthroscopy alone in borderline dysplastic patients at a minimum 2-year follow-up, even in those with greater hypermobility. These findings suggest that a combined approach may be preferable for BLD patients. Further research with longer follow-up is warranted to validate these outcomes