Painful Borderline Acetabular Dysplasia: What's New?

Developmental dysplasia of the hip (DDH) is a complex static-dynamic condition resulting in chronic joint instability and osteoarthritis. Borderline acetabular dysplasia refers to slightly abnormal patterns in the acetabular shape and coverage that are not within the dysplastic range. However, they can predispose to mechanical dysfunction and hip instability. Diagnosis and treatment remain controversial topics in hip preservation, with little current comparative literature to guide accurate diagnosis and treatment decision-making. Historically, the diagnosis of borderline DDH relied on assessments of the acetabular anatomy on anteroposterior pelvic radiography, most commonly the lateral central-edge angle (LCEA), with normal values ranging from 20 to 25° or, in some more recent studies, 18 to 25°. Surgical treatment decision-making debates the use of isolated hip arthroscopy or periacetabular osteotomy, considering the difficulty in determining a fundamental mechanical diagnosis (instability versus femoroacetabular impingement) in subjects with borderline DDH. Therefore, for effective surgical decision-making, the evaluation of additional bone anatomy characteristics, instability, and patients' features is essential.