Simultaneous periacetabular osteotomy and arthroscopically assisted treatment of cam-related pathology in acetabular dysplasia

Background: Acetabular dysplasia (AD) and femoroacetabular impingement (FAI) frequently coexist, with cam-type deformities occurring in 10% to 80% of dysplastic hips. While periacetabular osteotomy (PAO) is the established treatment for AD, suboptimal correction of associated cam lesions or intra-articular chondrolabral pathology can negatively impact long-term joint survivorship and accelerate the progression of osteoarthritis.

Objective: This article describes a specialized surgical technique combining PAO with traction-based, arthroscopically assisted intra-articular surgery to simultaneously address acetabular coverage, femoral asphericity, and chondrolabral lesions.

Key Points: Indications for this combined procedure include symptomatic AD (LCE angle <25°) with MRI-confirmed chondrolabral pathology and cam morphology (alpha angle >50°). Using a traction table and a modified anterior approach, a T-shaped capsulotomy allows for direct visualization and arthroscopic access to the central compartment. This enables precise labral refixation with suture anchors, chondral flap stabilization, or microfracture under distraction. Subsequent femoral osteochondroplasty is performed to restore head-neck offset. Following intra-articular repair, the PAO is completed using standard Bernese bone cuts to reorient the acetabular fragment. Mid-term data indicate that patients undergoing this combined approach achieve clinical outcomes comparable to those undergoing isolated PAO, without increased morbidity from the integrated procedure.

Conclusion: Integrating arthroscopically assisted intra-articular surgery with PAO allows for the comprehensive management of complex hip deformities in a single operative setting. This approach effectively addresses both extra-articular instability and intra-articular pathology, potentially optimizing joint mechanics and delaying osteoarthritic degeneration.