FP4.4 The Clinical Presentation of Borderline Acetabular Dysplasia: A multicenter prospective study

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Abstract Background: The optimal treatment of patients with symptomatic borderline acetabular dysplasia remains a major controversy in hip preservation. The literature on borderline dysplasia focuses on treatment of overlapping subgroups of this population, yet the entire population of patients with symptomatic borderline dysplasia remains to be better defined. The purpose of the current study was to define the clinical presentation of borderline acetabular dysplasia across the full spectrum of treatments with hip arthroscopy and/or periacetabular osteotomy. Methods: A prospective multicenter cohort study of the surgical treatment of borderline acetabular dysplasia was performed. All patients undergoing primary surgical treatment of hip pain in setting of borderline dysplasia [lateral center edge angle (LCEA) 18-25°] were included from 25 surgeons at 16 institutions. Exclusion criteria included revision surgery and diagnosis of Ehlers-Danlos syndrome. Clinical characteristics and imaging parameters were assessed in the entire population, regardless of treatment type. Results: The study cohort included 506 hips (74.7% female) with a mean age of 24.4+7.5 years (including 29.2% 18 years of age or younger). The LCEA was 18-20° in 27.3% and 20-25° in 72.7% with a relatively uniform distribution across the 18-25° range. The mean acetabular inclination was 9.1+4.4, with 35.1% in 10-15 range and 7.9% greater than 15. The mean baseline mHHS was 61.7+14.3, while iHOT-12 was 33.7+17.1. Pain was the primary patient-reported symptom in 70.8% of cases, compared to 18.2% for mobility and 5.3% for stability. Pain chronicity was less than 1 year in 36.9%, 1 to 3 years in 34.8%, and greater than 3 years in 28.3%. Pain was located in the anterior groin in 80.4% of patients, compared to 69.6% for lateral hip, 38.5% for posterior hip, and 22.9% for anterior thigh, with 79.6% of patients reporting at least one non-groin pain location. The Beighton score was 4+, 5+, and 8+ in 48.6%, 39.1%, and 11.3% of patients. Conclusions: Patients undergoing surgical treatment in setting of borderline acetabular dysplasia demonstrate significant variability including clinical presentation and radiographic morphology. Future research on outcomes of surgical intervention in setting of borderline dysplasia should investigate the role of these characteristics in the outcome of treatment.

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