EP1.53 Concomitant Periacetabular Osteotomy with Hip Arthroscopy Reduces Revision Rate in Borderline Dysplasia Patients Compared with Arthroscopy Alone

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ID: 331215
2026
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Abstract
Abstract Purpose To compare two-year patient-reported outcomes, satisfaction, and failure rates in young adults with borderline developmental dysplasia of the hip (BDDH) treated with hip arthroscopy (HA) alone versus HA combined with peri-acetabular osteotomy (HA+PAO). Hypothesis Both treatment groups would demonstrate clinically meaningful improvement and high satisfaction at two years, with a higher failure rate (conversion to PAO or other secondary procedures) expected among patients treated with HA alone. Methods We performed a retrospective, multicenter database study including consecutive primary HA procedures for BDDH performed between 2020 and 2023 in patients aged <25 years who had complete two-year outcome measures. Demographic and radiographic data collected included age, sex, Tönnis grade, lateral center-edge angle (LCEA), and acetabular index (AI). Patient-reported outcomes measured preoperatively and at two years included PROMIS Physical Function (PF), the International Hip Outcome Tool-12 (iHOT-12), and a 0–10 satisfaction score. Two-year analyses excluded patients who underwent any secondary surgery prior to the two-year timepoint. The study was powered a priori to detect a change in PROMIS PF, requiring a minimum of 17 patients per group; significance was set at p ≤ 0.05. Appropriate statistical tests were applied for within-group changes and between-group comparisons. Results The HA cohort comprised 23 patients (mean age 20.3 years; 100% female; 100% Tönnis grade 0) with mean LCEA/AI of 25.6°/7.3°. The HA+PAO cohort included 52 patients (mean age 19.9 years; 100% female; 100% Tönnis grade 0) with mean LCEA/AI of 22.3°/8.9°. Both groups demonstrated substantial within-group improvements at two years. PROMIS PF increased from 39.9 to 54.6 in the HA group and from 39.1 to 54.05 in the HA+PAO group (between-group difference p = 0.85). iHOT-12 improved from 40.3 to 74.1 in the HA group and from 37.4 to 76.4 in the HA+PAO group (between-group difference p = 0.85). Mean satisfaction scores were high in both cohorts (HA 9.3 vs HA+PAO 8.9; p = 0.37). Procedural failure, defined as conversion to PAO or progression to THA, differed significantly: 8 of 23 HA patients (34%) underwent conversion to PAO by 24 months, whereas 2 of 52 HA+PAO patients (4%) progressed to THA (between-group difference p = 0.003). Conclusion In young adults with BDDH, both HA alone and HA+PAO produced large, clinically meaningful improvements in hip-specific and general physical function and high satisfaction at two years. However, HA alone was associated with a substantial early conversion rate to PAO (34%), whereas progression to THA after HA+PAO was uncommon. These findings support thorough preoperative counseling and shared decision-making when considering isolated HA for BDDH, with clear discussion of the elevated risk of subsequent PAO and the potential need for staged or combined reconstruction in patients with borderline dysplasia. Further prospective studies are needed to refine selection criteria.
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Authors Robert C. Kollmorgen, Thomas J. Ellis, Joshua David Harris, Robroy Martin
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.237
URL
https://doi.org/10.1093/jhps/hnag043.237
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