Comparison Between Hip Arthroscopic Surgery and Periacetabular Osteotomy for the Treatment of Patients With Borderline Developmental Dysplasia of the Hip: A Systematic Review

Abstract

Background: The treatment for borderline developmental dysplasia of the hip (BDDH) has historically been arthroscopic surgery or periacetabular osteotomy (PAO). As orthopaedic surgery is constantly evolving, a lack of comparison of outcomes for these 2 treatment methods could potentially be stalling the progression of treatment for patients with BDDH. Purpose: To evaluate the existing literature on patient characteristics, procedures, clinical outcomes, and failure rates for patients with BDDH and to determine whether PAO or hip arthroscopic surgery is a better treatment method for patients with BDDH. Study Design: Systematic review; Level of evidence, 4. Methods: Studies included were found using the following search words: “hip” and “borderline dysplasia,” “osteotomy” or “arthroscopy,” and “outcome” or “procedure.” Articles were included if they detailed participants of all sexes and ages, reported on isolated hips, and had patients diagnosed with BDDH. Results: A search was conducted across 3 databases, resulting in 469 articles for consideration, from which 12 total studies (10 on arthroscopic surgery and 2 on PAO) were chosen for a review. There were 6 studies that included patients with a lateral center-edge angle of 18° to 25°, while the remainder included patients with a lateral center-edge angle of 20° to 25°. All the studies reviewing arthroscopic surgery reported concomitant/accessory procedures, while the articles on the topic of PAO did not. It was determined that, whether treated using arthroscopic surgery or PAO, outcomes improved across all patient-reported outcome measures. Revision surgery was also common in both procedures. Conclusion: There is a lack of consensus in the literature on the best treatment option for patients with BDDH. Preoperative patient characteristics and concomitant injuries should be considered when evaluating which surgical procedure will result in the most favorable outcomes.

Ten-Year Outcomes After Hip Arthroscopy in Patients With Femoroacetabular Impingement and Borderline Dysplasia

“…Of note, 94% of their patients demonstrated at least 1 These articles all recommend expanding the preoperative evaluation of the borderline hip to include more than the LCEA. 19,20,25,31 Limitations…”

“…These articles all recommend expanding the preoperative evaluation of the borderline hip to include more than the LCEA. 19,20,25,31…”

“…A recent systematic review compared hip arthroscopy and periacetabular osteotomy in patients with borderline dysplasia. 25 It revealed a lack of consensus on the best treatment method, but it did cite high revision rates. McClincy et al 19 published a minimum 2-year follow-up of 39 patients who underwent periacetabular osteotomy for borderline dysplasia, reporting no revisions or conversions to THA and with 94% achieving an mHHS of at least 70.…”

Top 100 cited studies in periacetabular osteotomy for acetabular dysplasia: do lower levels of evidence guide clinical practice?

“…Specifically, due to the learning curve and variation in training [12][13][14], included studies are frequently case series without adequate control cohorts. Similarly, although PAO remains highly successful for the treatment of acetabular dysplasia, debate remains regarding whether concomitant procedures, such as hip arthroscopy, should be part of standard perioperative care [15]. Thus, as surgical techniques adapt and surgeons become more familiar with the procedure, prospective, RCTs may become more feasible [16].…”

One Bony Morphology, Two Pathologic Entities: Sex-Based Differences in Patients With Borderline Hip Dysplasia Undergoing Hip Arthroscopy

“…55 In reality, hip dysplasia is a complex condition involving multiple relevant patient-specific variables. 58 Optimal treatment takes into account numerous patient-related factors and makes it difficult to devise rigid treatment algorithms, and there is still much to be learned about properly indicating these patients for surgery. 1 At the very least, this study supports a growing body of evidence indicating that with arthroscopic treatment alone, male and female patients with BHD can attain good outcomes.…”