title: The Dysplastic and Unstable Hip: A Responsible Balance of Arthroscopic and Open Approaches.
abstract: The treatment of young adult hip disorders, including hip dysplasia, has evolved significantly in the last decade. The association of hip dysplasia with hip osteoarthritis is well accepted, but remains based on basic radiographic parameters. Our understanding of the complexity and variability of hip dysplasia continues to evolve. As the clinical presentation of mild and borderline acetabular dysplasia is very similar to that of other young adult hip disorders, such as femoroacetabular impingement, a thorough history, physical examination, and radiographic evaluation are important to properly diagnose these patients. Acetabular reorientation via the periacetabular osteotomy has become the most common treatment for acetabular dysplasia with good outcomes reported at over 20 years postoperatively. The treatment of intra-articular labrochondral pathology and femoral head-neck offset abnormalities at the time of periacetabular osteotomy has become more common place with the theoretical goal of improving long-term outcomes. The borderline dysplastic hip remains a controversial topic, with significant overlap with other causes of hip microinstability such as connective tissue laxity. In the current article, we present a relevant review of the literature and a balanced approach to the treatment of acetabular dysplasia.
authors.affiliation: *St. Louis Children's Hospital †Department of Orthopaedic Surgery, Washington University School of Medicine ‡St. Louis Shriners Hospital §Barnes Jewish Hospital, St. Louis, MO.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Nepple
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult