The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

▪ Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI). ▪ Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain. ▪ Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis. ▪ Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO). ▪ FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery. ▪ If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO. ▪ THA can be performed following PAO with outcomes similar to a primary THA. ▪ Hip arthroscopy is indicated in FAI (cam and pincer) and/ or for labral tears.