Arthroscopic Hip Joint Assessment can Impact the Indications for PAO Surgery

Iowa Orthop J. 2019;39(1):149-157.


Background: The purpose of this study was to analyze clinical, radiographic and intraoperative disease characteristics of patients with symptomatic acetabular dysplasia in which periacetabular osteotomy (PAO) was contraindicated due to advanced intraarticular findings at the time of disease staging hip arthroscopy (HA).

Methods: A prospective cohort was used to identify all patients who were scheduled for a PAO and concomitant hip arthroscopy for the treatment of symptomatic acetabular dysplasia. From a total of 286 patients (286 hips), 11 patients (11 hips) were identified in whom the PAO was contraindicated due to the intraarticular findings of a disease-staging hip arthroscopy. Clinical characteristics, radiographic and intraoperative findings were analyzed and compared to those patients in whom the joint was judged to be appropriate for PAO surgery.

Results: 11 patients (11/286 or 4%), in whom a PAO was contraindicated after joint assessment with HA, were identified and included in this study. There were nine females and two males. All patients were potential candidates for PAO surgery. The PAO was contraindicated in these cases due to severe articular cartilage damage on both the femoral head and acetabulum. The patients when compared to those in which the PAO was performed, were significantly older (42.3 years (IQR, 38.1-46.8) vs. 24 years (IQR, 19-34)) (p<0.001) and had more severe dysplasia with a lower median lateral center-edge angle (LCEA, 12.9° vs. 17.7°, p=0.001) and lower anterior center-edge angle (ACE, 14.4° vs. 20.3°, p=0.021).

Conclusions: Patients in which the PAO was contraindicated, compared to those in which PAO was performed, were older and had significant more severe dysplasia. The main cause of intraoperative disqualification for PAO was advanced articular cartilage disease.Level of Evidence: IV.

Keywords: PAO; acetabular dysplasia; developmental dysplasia; hip arthroscopy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetabulum / surgery*
  • Adolescent
  • Adult
  • Arthroscopy / methods*
  • Cohort Studies
  • Contraindications, Procedure
  • Female
  • Follow-Up Studies
  • Hip Dislocation / diagnosis*
  • Hip Dislocation / surgery*
  • Hip Dislocation, Congenital / diagnosis
  • Hip Dislocation, Congenital / surgery
  • Humans
  • Male
  • Minimally Invasive Surgical Procedures / methods*
  • Osteotomy / adverse effects*
  • Prospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Treatment Outcome
  • Young Adult