AANA25 Hip Access Pass-CONCURRENT SESSION 5G: Hip Dysplasia & Extra-Articular Hip

Video Transcription

Video Summary

The 2025 hip preservation session offered a comprehensive overview of advancements and current debates around hip dysplasia and extra-articular hip pathology. Dr. Andrea Spiker traced hip preservation's evolution from the 1970s, highlighting milestones: the 1988 introduction of modern periacetabular osteotomy (PAO), the emergence of hip arthroscopy in the 1990s, and the 2000s discovery of femoroacetabular impingement’s (FAI) role in arthritis. Recent evidence indicates both PAO and hip arthroscopy can alter arthritis progression, especially in borderline hip dysplasia cases, though nuanced patient selection remains critical.<br /><br />Research shows hip arthroscopy can succeed in carefully chosen borderline dysplastic hips, but patients with additional morphologic instability often benefit more from PAO. Multiple studies reveal similar outcomes when comparing isolated arthroscopy to combined PAO and arthroscopy, but these groups differ in dysplasia severity, underscoring the importance of tailored treatment. Revision arthroscopy often yields inferior results, emphasizing the need for accurate initial diagnosis and intervention.<br /><br />Mental health’s impact on hip preservation outcomes was emphasized by Dr. John Ryan, highlighting high rates of depression and anxiety in this population that correlate with worse surgical outcomes and increased revision risk. He advocated for greater surgeon awareness, mental health screening, and integrated care approaches to optimize recovery.<br /><br />Subsequent talks addressed surgical techniques: Dr. Thomas Bird promoted endoscopic abductor repair over open surgery, citing fewer complications and better management of intra-articular pathology. Dr. Shane Ngo demonstrated an endoscopic proximal hamstring repair technique, emphasizing safety near neural structures and promising clinical outcomes.<br /><br />A debate between Drs. Robert Westerman and Linnea Welton focused on treating borderline dysplasia. Westerman supported hip arthroscopy for impingement-dominant cases with thorough intraoperative correction and capsular management, cautioning against arthroscopy in instability or severe dysplasia. Welton argued that PAO remains essential for borderline hips with instability features, citing higher success rates and cautioning against revision arthroscopy after failed arthroscopy.<br /><br />In summary, the session highlighted that successful hip preservation hinges on precise diagnosis encompassing bony anatomy, soft tissues, and patient factors including psychosocial health. Treatment must be individualized, balancing arthroscopic and open procedures to optimize function and longevity, particularly in borderline dysplasia. Integration of mental health care and advanced surgical techniques promises improved outcomes for this complex patient group.

Asset Caption

Keywords

hip preservation

hip dysplasia

periacetabular osteotomy

hip arthroscopy

femoroacetabular impingement

borderline dysplasia

mental health in surgery

endoscopic abductor repair

proximal hamstring repair

patient selection