Hip Arthroscopy in patients with Dysplasia

There continues to be quite a lot of debate regarding the role of hip arthroscopy in patients with acetabular dysplasia. Certainly most would now agree that severe or moderate dysplasia should be treated by an acetabular osteotomy such as the Periacetabular Osteotomy (PAO). There is, however, a grey area where the dysplasia may not look particularly severe and the presence of a labral tear producing pain would suggest that repairing this could be helpful. The issue with performing arthroscopy in the presence of significant dysplasia is that the hip can be made more unstable and become more painful, particularly if the labrum is removed. In milder cases clinical symptoms can be improved by arthroscopy but so far there is rather short term information as to how effective such treatment is in the longer term.

We have been doing a lot of research looking at the characteristics of hips where the dysplasia is considered to be mild by the usual x ray criteria. We have a lot of experience using CT scans over many years and it is clear that some hips which have apparently mild dysplasia on X ray have more significant dysplasia when measured in a 3 dimensional fashion from CT scans. This highlights the importance of careful characterisation of the dysplastic hip before commencing treatment.

Clearly if an arthroscopy is being undertaken in the context of a dysplastic hip  it is important to understand that a PAO may be required if the hip becomes more unstable afterwards and it is better to be forewarned of this so that it does not come as a shock later.

Ultimately, ongoing research into this area will allow us to inform patients more accurately about which surgical option will give them the better longterm outcome.