Editorial Commentary: Arthroscopic Treatment of Mild Hip Dysplasia Can Result in Excellent Outcome and Avoid More Invasive Periacetabular Osteotomy.

Several mechanisms either support or decrease stability of the hip joint. Primary stability of the hip comes from bony coverage of the femoral head, influenced by acetabular version and femoral antetorsion. In addition, soft tissue structures such as the acetabular labrum, the ligamentum teres, and the hip capsule play a significant role in maintaining joint stability. Untreated hip instability may lead to pathological force transmission between the acetabular socket and femoral head, and subluxation resulting in osteoarthritis. Historically, pelvic and/or femoral osteotomies have been performed to increase hip stability and prevent joint degeneration. However, osteotomies do not address soft tissue instability or lesions of intra-articular structures, which could explain symptoms following bony correction. Furthermore, the rate of combined pathologies resulting in hip instability and femoroacetabular impingement syndrome (FAIS) is high. Modern hip arthroscopy enables reconstruction and stabilization of soft tissue structures and the correction of bony pathologies caused by FAIS. Minimally invasive procedures can help avoid overtreatment and unnecessary risks associated with more invasive osteotomies. However, in cases of ongoing symptoms after arthroscopic treatment for mild instability, or for patients with severe dysplasia, concomitant PAO and arthroscopy can combine bony correction of a PAO with intra-articular therapies of hip arthroscopy.