Surgical Technique: Hip Arthroscopy for Hip Dysplasia

Abstract

Hip arthroscopy as a sole treatment strategy in patients with hip dysplasia has yielded variable results historically, including frank hip dislocations postoperatively and rapid degeneration leading to early osteoarthritis (OA) and total hip replacement (THR). Thus, the utility of hip arthroscopy for patients with hip dysplasia came into question as surgeons attempted to refine their indications. The authors posit that hip arthroscopy is an important part of the treatment algorithm for patients with hip dysplasia and can meaningfully address labral pathology, concomitant cam-type femoroacetabular impingement, acetabular subchondral cysts, capsular laxity, and ligamentum teres pathology. For patients with frank hip dysplasia, the intra-articular work performed during hip arthroscopy is routinely followed by extra-articular realignment with a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO). However, in select cases of borderline hip dysplasia, hip arthroscopy may be utilized as a sole first-line treatment, particularly when the combined torsion and version index (COTAV) and Beighton laxity score (BLS) are low. These patients require close monitoring during the first year of their postoperative rehabilitation as latent instability often presents with recurrent symptoms upon return to higher demand activities at the 6- to 12-month postoperative time point. In these instances, PAO surgery may be revisited when other causes for recurrent symptoms have been ruled out (i.e., adhesions, residual impingement, heterotopic ossification) and instability is deemed to be the most likely culprit.

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