AANA Lab Course 914 - Advanced Hip Arthroscopy-Arthroscopic Role and Management of Hip Dysplasia, Benjamin Domb, MD

Arthroscopic Role and Management of Hip Dysplasia, Benjamin Domb, MD

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Dr. Benjamin G. Domb discusses the role of arthroscopy in managing acetabular dysplasia, a condition characterized by a small or abnormally vertical acetabulum leading to hip pain, labral tears, and arthritis. Diagnosis hinges on radiographic criteria, especially the lateral center-edge angle (LCEA), with dysplasia defined as LCEA less than 20°. Untreated dysplasia results in eccentric cartilage loading, labral damage, and osteoarthritis.<br /><br />Treatment aims to improve femoral head coverage and hip stability, reducing overload and subluxation. The Peri-Acetabular Osteotomy (PAO) is the first-line surgical treatment for dysplasia (LCEA ≤20), correcting deformity by reorienting the acetabulum. Good PAO candidates are typically younger (<50 years), with minimal osteoarthritis and preserved joint space. Arthroscopy alone is generally not appropriate for true dysplasia but is used adjunctively, either concomitantly with PAO to address intraarticular pathologies (labral tears, chondral injuries, cam lesions), preoperatively for temporary pain relief, or post-PAO to manage persistent problems.<br /><br />Studies show intraarticular damage is present in 100% of dysplastic hips undergoing PAO, supporting combined arthroscopy and PAO for optimal results. Arthroscopy in borderline dysplasia (LCEA 18-25) can yield good outcomes, particularly in patients under 40 without advanced osteoarthritis, through labral repair, capsular plication to restore stability, and addressing femoroacetabular impingement lesions. Long-term follow-up demonstrates durable symptom improvement and low conversion to total hip replacement in well-selected patients.<br /><br />PAO remains the preferred treatment for significant dysplasia due to its correction of underlying anatomy, whereas arthroscopy plays a complementary role in addressing intraarticular pathology and symptom relief, especially in borderline cases or when PAO is not feasible. Preservation of the labrum and capsular structures is emphasized to optimize stability and outcomes.

Keywords

acetabular dysplasia

arthroscopy

peri-acetabular osteotomy (PAO)

lateral center-edge angle (LCEA)

labral tears

hip stability

femoroacetabular impingement

capsular plication

intraarticular pathology

osteoarthritis