Thanks for the introduction, and my co-authors and I would like to thank Anna for allowing us to present her research. A list of disclosures, none of which are relevant to this talk. So a little background, PAO has been shown to have good long-term results with survivorship over 60% at 20 years. There's been a high prevalence, however, of intraarticular pathology, which may lead to postoperative pain in these patients. So it begs the question, does concomitant hip arthroscopy play a role as a complementary tool during PAO? So advantages of concomitant procedure would be that you can perform a diagnostic arthroscopy. Arthroscopic treatment of pathology, including labral tears and various types of impingement, can be managed. Disadvantages, however, steep learning curve, requires a meticulous technique. The patient is on traction for a short period of time during the case. And fluid extravasation, however, may make the open procedure more difficult. In addition, there's a lack of long-term follow-up. So the purpose of this study was to report outcomes of concomitant PAO and hip arthroscopy in patients with a minimum five-year follow-up. We hypothesized that this procedure would result in favorable outcomes. So data was retrospectively reviewed and prospectively collected between 2010 and 2012. Inclusion criteria include all patients that underwent concomitant procedures and had minimum five-year follow-up for the various PRO measures that are listed below. We excluded all patients that underwent reverse PAO procedures. For definition purposes, dysplasia was defined as LCA less than or equal to 18 degrees and borderline between 19 and 25. Surgical technique, the top left corner shows the arthroscopic circumferential reconstruction that was done in this particular case. Labral preservation, as we heard in the last talk, obviously something we were hoping to do with the arthroscopic procedure. Labral repair versus reconstruction are viable options. After the arthroscopic portion was completed, the patient was remaining on the supine table was prepped and draped for the PAO portion of the case. We then went on to perform an open technique. After a few osteotomy cuts were made on the standard technique, we then performed a reduction and implantation and fixation of our periosteobular osteotomy, as seen here. One thing we do note is that if a capsule or plication is needed, this is done at the end of the PAO procedure. So again, fluid extravasation may be an issue because the capsule is left open during the PAO, as seen here. Preoperative and postoperative fractures can be seen. So results. We had 16 patients enrolled in the study, age 23.5, mean average, mostly female with a low BMI. Follow-up time can be seen as 66.4 months. We had a significant difference in LCA measurements as expected and an alpha angle measurement noting that we treated chemopathology that was treated. In addition, PRO measures all had significant improvements from preoperative to five-year follow-up. However, we wanted to see if the patients from the two-year mark to five-year mark had durable results. We found that there was no significant differences between two and five years. This is seen in the chart below, as well as in this graph here. So again, results were durable between two and five-year mark. So in discussion, the concomitant hip arthroscopy and PAO procedure appears to be safe, has been shown to have significant improvements in all PRO measures measured, and results remain durable between the two and five-year mark. The visualization that's achieved via the arthroscopic means allows for more accurate information and ability to preserve labrum and affect chondral damage inter-articularly. This has been shown in various other studies in the latest literature, again, comparing this labral preservation technique. And it's very, very limited at this point in time, but we are hoping that this technique is something that will help patients going forward in the future. So limitations, it's a non-randomized study and it has a lack of control group. It's a small sample size. And really, it does beg the question, does a concomitant hip arthroscopy and PAO make a substantial clinical difference? So it's yet to be seen. So in conclusion, concomitant hip arthroscopy and PAO appears to be a safe and effective procedure with favorable midterm outcomes that are durable compared to the short-term. Thank you.

concomitant hip arthroscopy

periacetabular osteotomy

advantages

diagnostic arthroscopy

treatment