Combined Periacetabular Osteotomy and Hip Arthroscopy Results in High Return to Sport Rates in Contact and Noncontact Athletes With Hip Dysplasia.

BACKGROUND: Prior studies of patients with hip dysplasia have documented 70% to 90% return to sport (RTS) with arthroscopy alone, 75% to 92% RTS with periacetabular osteotomy (PAO) alone, and approximately 82% to 86% RTS with combined PAO and hip arthroscopy. PURPOSE: To investigate the RTS rate in patients with hip dysplasia after combined PAO and hip arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This was a retrospective single-institution review of all patients who underwent a combined PAO and hip arthroscopy between 2016 and 2023. Inclusion criteria were hip dysplasia with a lateral center-edge angle (LCEA) <25° and documented participation in a sport or athletic activity undergoing a combined PAO and hip arthroscopy. Patients were excluded if they had follow-up for <6 months. Demographic data, modified Harris Hip Score (mHHS), RTS, and time to RTS were documented. Preoperative and postoperative radiographs were reviewed with documentation LCEA, extrusion index, acetabular index, and alpha angle. RESULTS: A total of 103 athletic hips in 84 patients were included with a mean age and body mass index of 20.3 ± 6.9 years and 23.9 ± 4.5, respectively. Mean LCEA and AI were 20.8°± 5.4° and 11.9°± 4.8°, respectively. Mean preoperative and postoperative alpha angles were 61.5° and 40.1°, respectively. Mean postoperative follow-up was 514.9 ± 326.5 days. From this cohort, 89.3% of hips returned to sport at a mean of 297.5 days. There was no significant association between RTS rates and any demographics, diagnoses, or preoperative and postoperative measurements. There was no significant association between RTS and mHHS. There was no significant association between degree of dysplasia and RTS. Contact athletes had an 82.5% RTS and noncontact athletes had a 93.7% RTS. CONCLUSION: This study showed that a combination hip arthroscopy and PAO for the treatment of hip dysplasia exhibited high levels of RTS at 89.3%. There were high rates of RTS in patients with severe dysplasia and those participating in contact sports, specifically. Combined procedures appear to be a very successful option for patients with hip dysplasia hoping to RTS at a high level.