Acetabular dysplasia is one of the leading causes of early coxarthrosis in young adults. In cases of borderline dysplasia and frank dysplasia, treatment selection varies depending on the presence of intra-articular pathologies and the degree of instability. In borderline dysplasia, labral tears, chondral damage, and ligamentum teres injuries are commonly encountered. Hip arthroscopy has been shown to be successful in these patients when appropriate patient selection and advanced techniques are applied. However, in cases with high-grade instability, hip arthroscopy alone may be insufficient, and the need for periacetabular osteotomy (PAO) may arise. In frank dysplasia, the primary issue is structural instability, and PAO is considered the gold standard treatment. By re-orientation of the acetabulum, PAO restores stability; however, intra-articular pathologies are not directly addressed. Therefore, the addition of arthroscopic procedures before, during, or after PAO has gained attention to improve joint preservation and prevent persistent symptoms. The aim of this study is to evaluate the timing, patient selection, and surgical strategies of combined hip arthroscopy and periacetabular osteotomy in the treatment of adult hip dysplasia. Treatment planning should be individualized based on the patient`s clinical and radiological findings, the presence of concomitant intra-articular pathologies, surgeon experience, and the available institutional infrastructure.