Editorial Commentary: Hip Arthroscopy in Dysplastic Hip Population? A Must, a Maybe, or a No Go?

Abstract

Treating symptomatic patients with dysplasia involves a controversy in therapy. The question is whether to obtain osseous correction with the help of pelvic reorientation osteotomy or to address intra-articular pathology with an arthroscopic approach. Neither isolated therapy nor the other method seems to be sufficient, but conducting both treatment options simultaneously has also not proved to be superior and carries the risk of additional complications. Different treatment options have been presented on this topic over the years and should be considered on a case-by-case basis. Pelvic reorientation osteotomy in patients with moderate to severe acetabular dysplasia remains uncontested, but it lacks the ability to obtain visualization of the central hip compartment. The isolated arthroscopic approach seems to be favorable for treatment of intra-articular pathologies in patients with mild to borderline dysplasia, whereas collateral arthroscopy in pelvic reorientation osteotomy may achieve better clinical outcomes in patients with more complex cases.

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

“…Although patients with frank hip dysplasia often require bony realignment through a PAO, 51 it is still unclear which patients with BHD should be treated with hip arthroscopy and/or a PAO. 34,50,58 Thus, in this review, we sought to examine the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. Using our results, it may be possible for surgeons to more accurately diagnose borderline or frank hip dysplasia preoperatively and to select which patients may benefit the most from an arthroscopic-only approach versus hip arthroscopy with a PAO.…”

“…Treatment with hip arthroscopy alone in patients with hip dysplasia has become a controversial topic (Table 3). 50 Multiple systematic reviews have examined outcomes of patients with dysplasia/BHD undergoing hip arthroscopy. 1,13,24,34,49,58 Three reviews 1,24,49 recommended against an arthroscopic-only approach in patients with moderate to severe dysplasia.…”

Presence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up

“…Acetabular dysplasia has been established as a risk factor for inferior outcomes following isolated hip arthroscopy without a periacetabular osteotomy [9e11]. However, the role of isolated arthroscopy in the setting of borderline or mild dysplasia is not clear [12], with some studies demonstrating good outcomes with long-term survivorship [13e15]. Acetabular retroversion is another form of acetabular pathomorphology which may predispose to FAIS and has been linked with early labral damage as compared to patients with isolated FAIS without retroversion given impaction of the femoral head-neck junction on the retroverted acetabular rim [16].…”