The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia is Increasing and Has Low Complication Rates

Purpose To analyze annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as post-operative outcomes, including ipsilateral reoperations. Methods Ninth and Tenth Revision codes of the International Classification of Diseases were used to query the PearlDiver™ Mariner database from January 2010 through January 2022 to identify patients aged 10-59 years who had a presenting diagnosis of HD and subsequently underwent: 1) HA; 2) PAO; or 3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days following HA). We analyzed annual rates for each treatment, as well as rates of post-operative emergency visits, readmissions and five-year ipsilateral secondary operations (determined via Kaplan-Meier analysis). Results There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the highest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, while PAO peaked in 2019. For HA, PAO, and HA-PAO, the majority of cases were performed in female patients and patients aged 30-49 years, 10-19 years, and 10-29 years, respectively. The five-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% CI: 8.6%- 9.8%) in the HA group and 6.5% (95% CI: 4.1%- 8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the highest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission. Conclusion HA is more frequently performed than PAO for hip dysplasia. HA-PAO is rising at the greatest rate, demonstrating fewer complications and reoperations.