Original Article| Volume 38, ISSUE 9, P2649-2658, September 2022

Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up


      To report minimum 2-year follow-up patient-reported outcomes and return-to-sport (RTS) rates in athletes undergoing concomitant hip arthroscopy and periacetabular osteotomy (PAO) to treat acetabular dysplasia and intra-articular pathologies such as cam deformity and labral tears.


      We reviewed the data of consecutive athletes undergoing concomitant primary hip arthroscopy and PAO for acetabular dysplasia and cam deformity from November 2010 to December 2018. Patients were included in the study if they had the following preoperative and minimum 2-year postoperative scores: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score–Sport-Specific Subscale (HOS-SSS). The percentage of patients who achieved the minimal clinically important difference was recorded, in addition to RTS status.


      A total of 29 athletes (29 hips) were included, with a mean follow-up time of 34.1 ± 7.9 months, mean age of 26.0 ± 8.7 years, and mean body mass index of 23.7 ± 3.4. These athletes showed significant improvements in the mHHS, NAHS, and HOS-SSS from baseline to latest follow-up (P < .001). The minimal clinically important difference was achieved at high rates for the mHHS (82.8%), NAHS (86.2%), and HOS-SSS (79.3%). Athletes who attempted to RTS successfully returned at a rate of 81.8%.


      Athletes undergoing concomitant hip arthroscopy and PAO showed significant improvements in patient-reported outcomes at minimum 2-year follow-up and had an RTS rate of 81.8%.

      Level of Evidence

      Level IV, retrospective case series.
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        • Kraeutler M.J.
        • Garabekyan T.
        • Pascual-Garrido C.
        • Mei-Dan O.
        Hip instability: A review of hip dysplasia and other contributing factors.
        Muscles Ligaments Tendons J. 2016; 6: 343-353
        • Matheney T.
        • Zaltz I.
        • Kim Y.J.
        • et al.
        Activity level and severity of dysplasia predict age at Bernese periacetabular osteotomy for symptomatic hip dysplasia.
        J Bone Joint Surg Am. 2016; 98: 665-671
        • Wyles C.C.
        • Heidenreich M.J.
        • Jeng J.
        • Larson D.R.
        • Trousdale R.T.
        • Sierra R.J.
        The John Charnley Award: Redefining the natural history of osteoarthritis in patients with hip dysplasia and impingement.
        Clin Orthop Relat Res. 2017; 475: 336-350
        • Clohisy J.C.
        • Barrett S.E.
        • Gordon J.E.
        • Delgado E.D.
        • Schoenecker P.L.
        Periacetabular osteotomy in the treatment of severe acetabular dysplasia. Surgical technique.
        J Bone Joint Surg Am. 2006; 88 (suppl 1, pt 1): 65-83
        • Ganz R.
        • Klaue K.
        • Vinh T.S.
        • Mast J.W.
        A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.
        Clin Orthop Relat Res. 1988; : 26-36
        • Novais E.N.
        • Duncan S.
        • Nepple J.
        • Pashos G.
        • Schoenecker P.L.
        • Clohisy J.C.
        Do radiographic parameters of dysplasia improve to normal ranges after Bernese periacetabular osteotomy?.
        Clin Orthop Relat Res. 2017; 475: 1120-1127
        • Pascual-Garrido C.
        • Harris M.D.
        • Clohisy J.C.
        Innovations in joint preservation procedures for the dysplastic hip “the periacetabular osteotomy.”.
        J Arthroplasty. 2017; 32: S32-S37
        • Steppacher S.D.
        • Tannast M.
        • Ganz R.
        • Siebenrock K.A.
        Mean 20-year followup of Bernese periacetabular osteotomy.
        Clin Orthop Relat Res. 2008; 466: 1633-1644
        • Yasunaga Y.
        • Ochi M.
        • Yamasaki T.
        • Shoji T.
        • Izumi S.
        Rotational acetabular osteotomy for pre- and early osteoarthritis secondary to dysplasia provides durable results at 20 years.
        Clin Orthop Relat Res. 2016; 474: 2145-2153
        • Domb B.G.
        • Lareau J.M.
        • Baydoun H.
        • Botser I.
        • Millis M.B.
        • Yen Y.M.
        Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?.
        Clin Orthop Relat Res. 2014; 472: 674-680
        • Domb B.G.
        • Lareau J.M.
        • Hammarstedt J.E.
        • Gupta A.
        • Stake C.E.
        • Redmond J.M.
        Concomitant hip arthroscopy and periacetabular osteotomy.
        Arthroscopy. 2015; 31: 2199-2206
        • Gala L.
        • Clohisy J.C.
        • Beaulé P.E.
        Hip dysplasia in the young adult.
        J Bone Joint Surg Am. 2016; 98: 63-73
        • Maldonado D.R.
        • LaReau J.M.
        • Perets I.
        • et al.
        Outcomes of hip arthroscopy with concomitant periacetabular osteotomy, minimum 5-year follow-up.
        Arthroscopy. 2019; 35: 826-834
        • McCarthy J.C.
        • Lee J.A.
        Acetabular dysplasia: A paradigm of arthroscopic examination of chondral injuries.
        Clin Orthop Relat Res. 2002; : 122-128
        • Parvizi J.
        • Bican O.
        • Bender B.
        • et al.
        Arthroscopy for labral tears in patients with developmental dysplasia of the hip: A cautionary note.
        J Arthroplasty. 2009; 24: 110-113
        • Ross J.R.
        • Zaltz I.
        • Nepple J.J.
        • Schoenecker P.L.
        • Clohisy J.C.
        Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia.
        Am J Sports Med. 2011; 39 (suppl): 72-78
        • Heyworth B.E.
        • Novais E.N.
        • Murray K.
        • et al.
        Return to play after periacetabular osteotomy for treatment of acetabular dysplasia in adolescent and young adult athletes.
        Am J Sports Med. 2016; 44: 1573-1581
        • Petrie J.R.
        • Novais E.N.
        • An T.W.
        • Clohisy J.
        • ANCHOR Study Group
        What is the impact of periacetabular osteotomy surgery on patient function and activity levels?.
        J Arthroplasty. 2020; 35: S113-S118
        • Okoroafor U.C.
        • Pascual-Garrido C.
        • Schwabe M.T.
        • Nepple J.J.
        • Schoenecker P.L.
        • Clohisy J.C.
        Activity level maintenance at midterm follow-up among active patients undergoing periacetabular osteotomy.
        Am J Sports Med. 2019; 47: 3455-3459
        • Bogunovic L.
        • Hunt D.
        • Prather H.
        • Schoenecker P.L.
        • Clohisy J.C.
        Activity tolerance after periacetabular osteotomy.
        Am J Sports Med. 2014; 42: 1791-1795
        • Parry J.A.
        • Swann R.P.
        • Erickson J.A.
        • Peters C.L.
        • Trousdale R.T.
        • Sierra R.J.
        Midterm outcomes of reverse (anteverting) periacetabular osteotomy in patients with hip impingement secondary to acetabular retroversion.
        Am J Sports Med. 2016; 44: 672-676
        • Sierra R.J.
        The management of acetabular retroversion with reverse periacetabular osteotomy.
        Instr Course Lect. 2013; 62: 305-313
        • Domb B.G.
        • Chen S.L.
        • Go C.C.
        • et al.
        Predictors of clinical outcomes after hip arthroscopy: 5-Year follow-up analysis of 1038 patients.
        Am J Sports Med. 2021; 49: 112-120
        • Domb B.G.
        • Martin T.J.
        • Gui C.
        • Chandrasekaran S.
        • Suarez-Ahedo C.
        • Lodhia P.
        Predictors of clinical outcomes after hip arthroscopy: A prospective analysis of 1038 patients with 2-year follow-up.
        Am J Sports Med. 2018; 46: 1324-1330
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Rybalko D.
        • Close M.R.
        • Litrenta J.
        • Perets I.
        Outcomes of hip arthroscopic surgery in patients with Tönnis grade 1 osteoarthritis at a minimum 5-year follow-up: A matched-pair comparison with a Tönnis grade 0 control group.
        Am J Sports Med. 2017; 45: 2294-2302
        • Wiberg G.
        Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip.
        J Bone Joint Surg Am. 1953; 35-A: 65-80
        • Nötzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560
        • Lequesne M.
        • de Seze S.
        False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies.
        Rev Rhum Mal Osteoartic. 1961; 28 ([in French]): 643-652
        • Ashberg L.
        • Charharbakhshi E.O.
        • Perets I.
        • Yuen L.C.
        • Walsh J.P.
        • Domb B.G.
        Hip arthroscopic surgery with labral preservation and capsular plication in patients with borderline hip dysplasia: Minimum 5-year patient-reported outcomes: Response.
        Am J Sports Med. 2019; 47: NP32-NP33
        • Chandrasekaran S.
        • Darwish N.
        • Martin T.J.
        • Suarez-Ahedo C.
        • Lodhia P.
        • Domb B.G.
        Arthroscopic capsular plication and labral seal restoration in borderline hip dysplasia: 2-Year clinical outcomes in 55 cases.
        Arthroscopy. 2017; 33: 1332-1340
        • Domb B.G.
        • Stake C.E.
        • Lindner D.
        • El-Bitar Y.
        • Jackson T.J.
        Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: Two-year clinical outcomes of a surgical approach to a challenging problem.
        Am J Sports Med. 2013; 41: 2591-2598
        • Briggs K.K.
        • Bolia I.K.
        Hip arthroscopy: An evidence-based approach.
        Lancet. 2018; 391: 2189-2190
        • Griffin D.R.
        • Dickenson E.J.
        • Wall P.D.H.
        • et al.
        Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): A multicentre randomised controlled trial.
        Lancet. 2018; 391: 2225-2235
        • Domb B.G.
        • Domb B.
        • LaReau J.
        • Redmond J.M.
        Combined hip arthroscopy and periacetabular osteotomy: Indications, advantages, technique, and complications.
        Arthrosc Tech. 2014; 3: e95-e100
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Outerbridge R.E.
        The etiology of chondromalacia patellae.
        J Bone Joint Surg Br. 1961; 43-B: 752-757
        • Callaghan J.J.
        • Rosenberg A.G.
        • Rubash H.E.
        The adult hip.
        Lippincott Williams & Wilkins, Philadelphia2007
        • Botser I.B.
        • Martin D.E.
        • Stout C.E.
        • Domb B.G.
        Tears of the ligamentum teres: Prevalence in hip arthroscopy using 2 classification systems.
        Am J Sports Med. 2011; 39 (suppl): 117-125
        • Murphy S.B.
        • Millis M.B.
        Periacetabular osteotomy without abductor dissection using direct anterior exposure.
        Clin Orthop Relat Res. 1999; 364: 92-98
        • Lodhia P.
        • Chandrasekaran S.
        • Gui C.
        • Darwish N.
        • Suarez-Ahedo C.
        • Domb B.G.
        Open and arthroscopic treatment of adult hip dysplasia: A systematic review.
        Arthroscopy. 2016; 32: 374-383
        • Aprato A.
        • Jayasekera N.
        • Villar R.N.
        Does the modified Harris Hip Score reflect patient satisfaction after hip arthroscopy?.
        Am J Sports Med. 2012; 40: 2557-2560
        • Christensen C.P.
        • Althausen P.L.
        • Mittleman M.A.
        • Lee J.-A.
        • McCarthy J.C.
        The Nonarthritic Hip Score: Reliable and validated.
        Clin Orthop Relat Res. 2003; : 75-83
        • Kersten P.
        • White P.J.
        • Tennant A.
        Is the pain visual analogue scale linear and responsive to change? An exploration using Rasch analysis.
        PLoS One. 2014; 9e99485
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the Hip Outcome Score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592
        • Chahal J.
        • Thiel G.S.V.
        • Mather R.C.
        • Lee S.
        • Salata M.J.
        • Nho S.J.
        The minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Orthop J Sports Med. 2014; 2 (suppl)2325967114S00105
        • Chahal J.
        • Van Thiel G.S.
        • Mather R.C.
        • et al.
        The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Am J Sports Med. 2015; 43: 1844-1849
        • Rosinsky P.J.
        • Kyin C.
        • Maldonado D.R.
        • et al.
        Determining clinically meaningful thresholds for the Non-arthritic Hip Score in patients undergoing arthroscopy for femoroacetabular impingement syndrome.
        Arthroscopy. 2021; 37: 3113-3121
        • Ricciardi B.F.
        • Fields K.G.
        • Wentzel C.
        • Nawabi D.H.
        • Kelly B.T.
        • Sink E.L.
        Complications and short-term patient outcomes of periacetabular osteotomy for symptomatic mild hip dysplasia.
        Hip Int. 2017; 27: 42-48
        • Sucato D.J.
        • Tulchin K.
        • Shrader M.W.
        • DeLaRocha A.
        • Gist T.
        • Sheu G.
        Gait, hip strength and functional outcomes after a Ganz periacetabular osteotomy for adolescent hip dysplasia.
        J Pediatr Orthop. 2010; 30: 344-350
        • Zaltz I.
        • Baca G.
        • Kim Y.J.
        • et al.
        Complications associated with the periacetabular osteotomy: A prospective multicenter study.
        J Bone Joint Surg. 2014; 96: 1967-1974
        • Edelstein A.I.
        • Nepple J.J.
        • Abu-Amer W.
        • Pascual-Garrido C.
        • Goss C.W.
        • Clohisy J.C.
        What mid-term patient-reported outcome measure scores, reoperations, and complications are associated with concurrent hip arthroscopy and periacetabular osteotomy to treat dysplasia with associated intraarticular abnormalities?.
        Clin Orthop Relat Res. 2021; 479: 1068-1077
        • Kim K.I.
        • Cho Y.J.
        • Ramteke A.A.
        • Yoo M.C.
        Peri-acetabular rotational osteotomy with concomitant hip arthroscopy for treatment of hip dysplasia.
        J Bone Joint Surg Br. 2011; 93-B: 732-737
        • Redmond J.M.
        • Gupta A.
        • Stake C.E.
        • Domb B.G.
        The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy: Arthroscopy versus arthrotomy.
        Arthroscopy. 2014; 30: 382-388
        • Krych A.J.
        • Thompson M.
        • Larson C.M.
        • Byrd J.W.T.
        • Kelly B.T.
        Is posterior hip instability associated with cam and pincer deformity?.
        Clin Orthop Relat Res. 2012; 470: 3390-3397
        • Wells J.
        • Schoenecker P.
        • Duncan S.
        • Goss C.W.
        • Thomason K.
        • Clohisy J.C.
        Intermediate-term hip survivorship and patient-reported outcomes of periacetabular osteotomy: The Washington University experience.
        J Bone Joint Surg Am. 2018; 100: 218-225
        • Jimenez A.E.
        • Monahan P.F.
        • Miecznikowski K.B.
        • et al.
        Achieving successful outcomes in high-level athletes with borderline hip dysplasia undergoing hip arthroscopy with capsular plication and labral preservation: A propensity-matched controlled study.
        Am J Sports Med. 2021; 49: 2447-2456