EP1.68 Combined Hip Arthroscopy and Periacetabular Osteotomy in a Single Surgical Setting for the Treatment of Symptomatic Adult Hip Dysplasia

Abstract

Abstract Purpose To analyze patient-reported outcome measures (PROMs), radiographic outcomes, operative time, and complication rates in patients undergoing periacetabular osteotomy (PAO) combined with hip arthroscopy in a single surgical setting for the treatment of intra-articular pathology. Methods A retrospective study was conducted including a consecutive series of 63 patients who underwent combined hip arthroscopy and periacetabular osteotomy in a single surgical setting under one anesthesia between 2011 and 2025 at a single institution, constituting the study group. During the same period, 78 patients with hip dysplasia were treated with isolated PAO in a non-randomized fashion, constituting the control group. Both groups together formed a final cohort of 141 patients. Baseline characteristics were comparable between groups (p>0.05). Radiographic variables were assessed in patients with complete imaging data. In the study group, arthroscopic findings and intra-articular procedures were analyzed. Outcome measures included mHHS, HOOS, and UCLA scores, as well as postoperative complications classified according to the Clavien-Dindo system. Results Significant radiographic improvement was observed in both groups. In the isolated PAO group, LCEA improved from 20.75 ± 8.59° to 33.74 ± 5.34°, while in the combined group it improved from 20.46 ± 8.92° to 33.05 ± 7.88° (both p<0.001). The magnitude of correction was similar between groups (12.99 ± 7.2° vs 12.59 ± 7.8°; p=0.74), with no differences in postoperative LCEA (p>0.05). In the PAO + arthroscopy group (n=63), labral repair was performed in 48 patients (77.4%), with a mean of 2.1 ± 0.8 anchors per case (range 1–3). No repair was required in 22.6%, including cases treated with debridement or radiofrequency stabilization, while in 2 patients (3.2%) no intra-articular lesions requiring treatment were identified. Operative time was significantly longer when both techniques were combined (132.4 ± 57.8 min) compared to isolated PAO (109.6 ± 39.2 min; p=0.015). Significant postoperative improvements were observed in all PROMs: mHHS (63.3 ± 8.8 to 93.1 ± 8.0), HOOS (61.6 ± 8.3 to 92.3 ± 8.5), and UCLA (all p<0.01). MCID and PASS were achieved in over 95% of patients for mHHS and HOOS, while SCB was achieved in approximately 70%. The overall complication rate was low and comparable between groups (5.1% vs 9.5%; p=0.25), with no differences in reoperation rates. Complications were mainly related to the osteotomy procedure. Conclusion The combination of hip arthroscopy and periacetabular osteotomy in a single surgical setting for the treatment of symptomatic adult hip dysplasia demonstrated excellent clinical and radiographic outcomes without increasing complication rates. Although intra-articular lesions were identified and treated in 97% of cases, these results did not differ significantly from those of isolated periacetabular osteotomy.