EP1.87 Impingement-Dominant Morphology is Associated with the Lowest Risk of Clinical Failure following Isolated Hip Arthroscopy for Borderline Dysplasia: A Data-Driven Phenotyping Study

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ID: 331284
2026
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Abstract
Abstract Background Outcomes following primary isolated hip arthroscopy in patients with borderline acetabular dysplasia remain heterogeneous. While previous studies have highlighted potential individual risk factors, their interactions and resulting composite risk phenotypes remain unknown. Methods Patients undergoing primary hip arthroscopy with radiographic borderline dysplasia (lateral center-edge angle 18°–25°) and minimum 2-year follow-up were retrospectively identified. Unsupervised hierarchical clustering was performed on preoperative variables to define distinct morphologic phenotypic subgroups and validated with aggregated domain-specific (demographic, clinical, comorbidity, coverage, impingement, and degeneration) Z-scores. The primary outcomes included structural failure (defined as revision arthroscopy, periacetabular osteotomy [PAO], or conversion to total hip arthroplasty [THA]) or clinical failure (defined as failure to achieve PASS on any/all validated hip specific patient reported outcome measures [PROM]s) at final follow-up, analyzed using competing risks analysis with Fine-Gray modeling. Results A total of 233 patients met inclusion criteria. Clustering identified the following three distinct patient phenotypes based on domain-specific Z-scores. (1) Female preserved: a young, predominantly female group with relatively preserved hip morphology (Z-scorecoverage: 0.07, Z-scoreimpingement: -0.13); (2) Degenerative: an older cohort with increased comorbidity burden (Z-scorecomorbidity: 0.14) and early degenerative features (Z-scoredegeneration: 0.21): ; and (3) Impingement dominant: a mixed-sex group characterized by greater impingement morphology and reduced hip range of motion (Z-scorecoverage: 0.127, Z-scoreimpingement: 0.09). While there were no significant differences in structural failure rates between the three groups on adjusted competing risk analysis, impingement dominant phenotype was independently associated with the lowest risk of clinical failure at final follow-up compared to female preserved (OR All: 2.28 [95%CI: 1.18-2.44], P=0.015) and degenerative phenotypes (OR All: 3.37 [95%CI: 1.88-4.06], P=0.001; OR Any: 3.12 [95%CI: 1.99-9.57], P=0.047), respectively. Conclusions A data-driven approach identified three clinically distinct failure profiles among patients with borderline dysplasia undergoing hip arthroscopy. Patients with impingement dominant phenotype demonstrated the lowest risk of clinical failure at final follow-up compared to female preserved and degenerative phenotypes. Phenotype-based stratification may improve preoperative counseling and surgical decision-making beyond traditional risk factor assessment.
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Authors Yining Lu, Ty Monty, Jack Yang, Joseph Brinkman, Joel Williams, Shane Nho
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.271
URL
https://doi.org/10.1093/jhps/hnag043.271
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