Current perspectives on the surgical treatment of femoroacetabular impingement patients with borderline developmental dysplasia of the hip

Femoroacetabular impingement (FAI) is a condition characterized by abnormal contact between the femoral head and the acetabulum, leading to intra- articular pathology in the hip joint. This review focuses on the complex scenario of FAI combined with borderline developmental dysplasia of the hip (BDDH), exploring the need for tailored surgical interventions to address bony deformities and intra-articular pathologies. This review investigated the different surgical treatment options available to the population with concomitant FAI and BDDH. In this patient group, surgical indications and postoperative outcomes were examined. The review drew upon 22 studies reporting postoperative results after hip arthroscopy and 4 studies reporting those after periacetabular osteotomy (PAO) assessing patient reported outcomes (PROs), patient satisfaction, revision rates, and factors influencing poor clinical outcomes. The synthesis of evidence involved a comparative analysis of hip arthroscopy and PAO outcomes. PROs improvements, revision rates, and predictors of success or failure were scrutinized. Noteworthy findings included the variability in outcomes based on age, BMI, and specific radiographic parameters. The review proposes a nuanced treatment algorithm, suggesting factors that guide the choice between hip arthroscopy and PAO, aiming for personalized surgical decisions. This review underscored the intricate nature of FAI with BDDH and the need for personalized treatment strategies. While both hip arthroscopy and PAO showed positive outcomes, the choice between them should be guided by specific patient characteristics. The proposed algorithm provides a framework for clinicians to navigate this complexity, emphasizing the importance of evidence synthesis in refining surgical decisions for optimal outcomes in FAI patients with BDDH.