What did the study look at?
Borderline hip dysplasia (BHD) is a form of developmental hip dysplasia in which the hip socket (acetabulum) is shallower than normal and loads across the hip are unevenly distributed. The authors note that it is a common cause of hip pain, especially in young and active people, and can predispose to early arthritis and chronic pain. This publication is not a study presenting new patient data but a review of existing scientific literature. Its aim is to set out the examination findings, radiological assessment, non-operative treatments and surgical options used in this condition.
How was it done?
The authors summarised the literature under the headings of anatomy, clinical complaints, physical examination, imaging, conservative treatment and surgical treatment. The text is illustrated with cadaveric dissection, X-ray, computed tomography and arthroscopy images.
What did it find?
- Anatomy: As the socket becomes shallower, the ring of cartilage around it (labrum) and the joint capsule carry more load and thicken; over time labral tears and pain from overworked muscles around the hip may develop.
- Symptoms: Patients usually present with groin pain that begins gradually and is related to activity. Signs of femoroacetabular impingement syndrome (FAIS) and hip instability often overlap.
- Examination: Gait analysis, the log roll test, range-of-motion measurement and specific manoeuvres for instability are described; the review reports that the abduction–hyperextension–external rotation test, performed lying on the side, has been shown to be the most sensitive and specific test for instability.
- Imaging: Diagnosis relies largely on plain X-rays. A lateral centre-edge angle (LCEA) of 20–25 degrees is generally accepted as borderline dysplasia, although some studies have used 18–25 or 16–25 degrees. The Tönnis and Sharp angles, the anterior centre-edge angle, the FEAR index, MRI and CT also help with assessment.
- Non-operative treatment: Options include physiotherapy, activity modification, patient education and anti-inflammatory medication. The authors report that current recommendations place hip-focused physiotherapy with an experienced therapist as first-line treatment.
- Surgical treatment: Hip arthroscopy and periacetabular osteotomy (PAO) are the main options. In arthroscopy, preserving and repairing the labrum, careful handling of the capsule and closing it at the end of surgery are highlighted. One cited study found survivorship after arthroscopy of 98.2% at mid-term and 76.3% at long-term follow-up.
The authors' conclusion
The authors conclude that although there is no gold standard for the surgical treatment of borderline hip dysplasia, clinical improvement has been reported after both arthroscopy and PAO. Good results depend on correctly identifying the underlying problem, choosing appropriate surgical indications and using the right technique. Decisions should be based on a comprehensive assessment and tailored to the individual patient, and in patients undergoing arthroscopy, correct management of the hip capsule is an important factor in the outcome.
Reference
İnan İH, Beyzadeoğlu T, Gürsoy S. (2025). Sınırda kalça displazisinin tanı ve tedavi yöntemleri: Güncel yaklaşımlar ve cerrahi seçenekler [Diagnosis and treatment methods of borderline hip dysplasia: Current approaches and surgical options]. TOTBİD Derleme Dergisi, 24(3):281-291. Article in Turkish with an English abstract.
DOI: 10.5578/totbid.derleme.dergisi.2025.41
Free full text: TOTBİD Derleme Dergisi (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
