Hip Instability and Dysplasia: From Microinstability to PAO

Hip instability covers a spectrum, from subtle microinstability in a flexible athlete to overt dysplasia where the socket does not adequately cover the femoral head.

Symptoms

• A sense of the hip giving way or sliding
• Front or side hip pain with loading
• Difficulty with single-leg activities
• Pain that worsens with end-range positions in dance, gymnastics or yoga

Why the diagnosis changes the surgery

Arthroscopy alone in a dysplastic hip can make instability worse. When the socket is truly shallow, a periacetabular osteotomy (PAO) reorients the acetabulum to provide durable coverage — sometimes combined with arthroscopic labral and cartilage work.

For microinstability with adequate coverage, arthroscopic capsular repair or capsular reconstruction restores the soft-tissue restraints. Revision cases after an unrepaired capsulotomy often fall into this group.