Borderline Hip Dysplasia: Hip Arthroscopy vs. Periacetabular Osteotomy (2025 Annual Meeting)-Borderline Hip Dysplasia: Hip Arthroscopy vs. Periacetabular Osteotomy

Video Transcription

Video Summary

This comprehensive panel discussion focused on borderline hip dysplasia, exploring diagnostic challenges and treatment options between hip arthroscopy and periacetabular osteotomy (PAO). Dr. Matthew Kraler emphasized that defining borderline dysplasia by lateral center edge angle alone (typically 18-25°) is insufficient, advocating instead for assessment of hip instability using multiple clinical, radiographic, and intraoperative factors such as the Baten hypermobility score, joint space width, labral hypertrophy, and femoral torsion. Dr. Derek Ochiai highlighted that physical exam findings overlap between borderline dysplasia and microinstability, recommending a battery of tests (e.g., anterior apprehension, prone external rotation) to increase diagnostic accuracy.<br /><br />Dr. Shane Ngo (presented by Dr. Ochiai) argued for hip arthroscopy alone in select borderline cases with less severe instability and good cartilage status, showing mid-term good outcomes, especially with capsular management and labral preservation. Contrastingly, Dr. Ernie Sink advocated for PAO as the gold standard, stressing that PAO addresses the fundamental bony deficiency in dysplasia, altering joint mechanics and natural history, and highlighting the importance of three-dimensional imaging beyond lateral center edge angles. He noted PAO’s low complication rates, reproducible outcomes, and its role in preventing osteoarthritis progression.<br /><br />Dr. Kraler supported a combined approach (hip arthroscopy plus PAO) in borderline dysplasia with instability and concomitant femoroacetabular impingement, citing evidence that arthroscopic femoroplasty reduces revision rates compared to open procedures. The combined surgeries may be staged closely to minimize post-arthroscopy instability and reduce adhesions. Panelists discussed operative goals such as optimal correction angles, importance of pelvic tilt during surgery, and femoral version's impact on decision-making.<br /><br />Overall, the consensus is that management of borderline hip dysplasia requires nuanced evaluation beyond simple angles, integrating patient activity, anatomy, and pathology to tailor treatment—ranging from arthroscopy alone in mild, stable cases to PAO or combined procedures in those with significant instability—to optimize long-term hip preservation and function.

Asset Caption

Matthew J. Kraeutler, M.D. | Ernest L. Sink, M.D. | Shane J. Nho, M.D., M.S. | Thomas H. Wuerz, M.D. | Omer Y. Mei-Dan, M.D.

Keywords

borderline hip dysplasia

hip arthroscopy

periacetabular osteotomy

lateral center edge angle

hip instability

Baten hypermobility score

femoral torsion

microinstability

capsular management

femoroacetabular impingement