The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip

Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI). Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain. Hip dysplasia can be diagnosed by measuring a CE angle <25 degrees on a plain standing radiograph of the pelvis. Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO). FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery. If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space <3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO. THA can be performed following PAO with outcomes similar to a primary THA. Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears.