EP31 An Updated Cost Analysis of Single-Stage Vs. Two Staged Hip Arthroscopy and Periacetabular Osteotomy in Adolescents and Adults with Hip Dysplasia and FAI Syndrome

Abstract Background Acetabular dysplasia and femoroacetabular impingement syndrome (FAIS) are common sources of hip pain in adolescents and adults. When both conditions coexist, patients have increased risk for hip instability and early osteoarthritis. Surgical management commonly involves addressing both intra-articular and structural abnormalities via hip arthroscopy and periacetabular osteotomy (PAO), respectively. These can be performed as a single combined surgery or as two separate staged surgeries. While both approaches yield comparable patient-reported outcomes, limited data exist comparing their direct costs. Given the complexity and potential financial burden of hip preservation procedures, this study aims to compare the direct costs and resource utilization of single-stage versus two-stage hip arthroscopy and PAO. Methods A retrospective review was conducted of patients treated at a single institution between January 1, 2023, and January 1, 2024. Inclusion criteria included patients aged 12–50 years undergoing either a two-staged or single-staged hip arthroscopy with labral repair and PAO for labral pathology and/or hip dysplasia. Exclusion criteria included osteoarthritis, prior ipsilateral hip surgery, inadequate medical records, undergoing concomitant derotational femoral osteotomy (DFO), specific non-repair labral procedures including augmentation, reconstruction, debridement, and additional procedures such as microfracture or peritrochanteric procedures (ie. bursectomy, gluteus repair). Cost analysis was performed using time-driven activity-based costing to capture direct costs. Results For preliminary analysis 110 patients were screened, of which 75 met inclusion and exclusion criteria. The single-stage approach demonstrated a 21% reduction in operating room time, 44% reduction in anesthesia costs, and 23% reduction in operating room staffing costs compared to the two-staged approach. Overall, the single-stage approach was 17% less expensive when comparing anesthesia and operating room staffing costs. Patient demographics, length of stay, recovery time, cost data including consumables, inpatient, outpatient, perioperative medications, imaging, surgical instrument utilization, and physical therapy are currently being collected to complete the full analysis. Conclusion Preliminary findings suggest that a single-stage combined PAO and hip arthroscopy approach is more cost-effective than a two-stage procedure, driven primarily by reductions in operating time, anesthesia, and staffing. Ongoing analysis will include comprehensive perioperative and post-operative costs to better inform surgical planning and resource allocation in this complex patient population.