Comparing 2-Year Outcomes between Hip Arthroscopy and Periacetabular Osteotomy for Acetabular Dysplasia With Femoroacetabular Impingement Syndrome vs. Hip Arthroscopy Alone for Femoroacetabular Impingement Syndrome Without Dysplasia

Background: Hip arthroscopy for femoroacetabular impingement syndrome (FAIS) yields excellent clinical outcomes. However, untreated concomitant acetabular dysplasia is associated with higher failure rates after arthroscopy. A combined approach of hip arthroscopy and periacetabular osteotomy (PAO) has shown promising results, but it remains unclear whether outcomes are equivalent to those of arthroscopy alone for FAIS without dysplasia. Purpose/Hypothesis: The primary purpose of this study was to compare 2-year patient-reported outcome (PROs) between patients with FAIS and acetabular dysplasia treated with staged hip arthroscopy and PAO and nondysplastic patients with FAIS treated with hip arthroscopy alone. The secondary purpose was to identify independent predictors of PROs at 2 years postoperatively. It was hypothesized that patients with FAIS and acetabular dysplasia treated with arthroscopy and PAO would demonstrate similar 2-year PROs compared with nondysplastic FAIS patients treated with arthroscopy alone. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 147 patients who underwent hip arthroscopy for FAIS were identified, including 23 patients in the dysplastic group and 124 in the control group. PROs were assessed at 2 years using Mental Health Inventory (MHI-5), 12-item international Hip Outcome Tool (iHOT-12), Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), University of California Los Angeles (UCLA) Activity Scale, Adult Single Item Measure (SIM) of Physical Activity, Patient Acceptable Symptom State (PASS) single item, and repeat surgery. Multivariate analyses adjusted for baseline demographics, preoperative superior joint space width, prior corticosteroid injection, and mental health status. Results: The dysplastic group was younger (mean age, 27.9 ± 8.7 years) and predominantly female (95.7%) compared with the control group (36.3 ± 12.8 years; 80.6% female) (age, P = .003; sex, P = .046, respectively). No differences were observed in 2-year iHOT-12 scores (67.20 vs 62.05; P = .45, respectively) or PASS achievement (69.56% vs 54.84; P = .18). On multivariate analysis, dysplasia was not an independent predictor of iHOT-12 score, PASS, or unplanned additional surgery. Preoperative joint space width was a significant predictor of revision surgery (adjusted odds ratio, 4.17; 95% CI, 1.49-11.1; P = .006). Conclusion: The treatment of FAIS with concomitant acetabular dysplasia with hip arthroscopy and PAO has similar 2-year PROs to patients with FAIS without dysplasia treated with arthroscopy alone.