Novel PATH score predicts treatment with periacetabular osteotomy versus isolated hip arthroscopy for patients with borderline hip dysplasia at a specialty hip centre

Abstract In patients with borderline hip dysplasia (BHD), radiographic and clinical variables influence in the decision to treat the painful hip with periacetabular osteotomy (PAO) versus isolated hip arthroscopy (iHA). The purpose of this study focusing on adolescent and young adult patients with BHD was to evaluate the surgical decision-making process at a specialist hip centre and to identify a combination of variables that predict treatment with PAO or iHA. Accordingly, patient demographics, baseline radiographic variables, and several clinical variables were recorded for 68 patients treated surgically for BHD. While a number of variables were associated with treatment decision, regression analysis showed that sex, femoral version, femoro-epiphyseal acetabular roof (FEAR) index, and anterior centre edge angle were principal predictors of treatment. The PAO versus Arthroscopic Treatment of the Hip (PATH) score was defined (one point for anterior centre edge angle < 25°, one point for FEAR index > − 3°, and one point for femoral version ≥15°). Among patients without prior contralateral hip surgery, males were treated with iHA unless they had a maximum PATH score of 3 (PAO), while females with PATH score ≥ 2 were universally treated with PAO. Females with PATH score ≤ 1 were variably treated with PAO or iHA, underscoring the need for clearer guidelines regarding indications and improved microinstability testing in this subgroup.