EP2.21 Periacetabular Osteotomies Lead to Improved Long-Term Patient-Reported Outcomes: A Systematic Review Open Access

Introduction: Periacetabular osteotomy (PAO) has demonstrated favorable outcomes for the treatment of hip dysplasia at short and midterm follow-up. The durability of these outcomes at long term follow-up is still being established. The primary purpose of this study was to conduct a comprehensive systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO.

Method: A systematic review of the literature was conducted in August 2023, with the following keywords: (periacetabular osteotomy) AND (patient-reported) AND (outcomes) in PubMed, Cochrane, and Scopus. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria was used. Only studies that reported on patient-reported outcomes with a mean of 10-year follow-up were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, patient-reported outcomes, psychometric thresholds, and secondary surgeries.

Results: A total of 8 studies covering 984 patients who underwent periacetabular osteotomies were included in this systematic review. Five studies were level III evidence and 3 were level IV. The mean study follow-up periods ranged between 120.0-348.2 months. The mean ages within studies ranged between 23.0 to 39.9 years at the time of surgery. Seven out of 8 studies reported a significant improvement between preoperative and postoperative PROs with the remaining study not including preoperative PROs. Mean modified Harris Hip Scores (mHHS) ranged from 61.9-83.0 preoperatively compared to 84.6-97.0 postoperatively. Mean Merle d’Aubigne-Postel scores ranged from 14.0-15.0 preoperatively and 16.0-17.0 postoperatively. Overall, secondary surgery rates ranged from 1.9-57.3% with conversion to THA rates of 0-56%. Significant risk factors for failure of PAO, defined as conversion to THA, and/or poor outcomes scores, included increasing age at the time of surgery (four studies), preoperative arthritis (Tönnis Grade >1, four studies), postoperative anterior femoral coverage >27 degrees (2 studies), and preoperative patient-reported scores (Postel score <15, 2 studies).

Conclusion: Patients undergoing PAO surgery for the treatment of hip dysplasia demonstrated significant improvement in PROs, but studies demonstrated variable rates of secondary surgeries at mean 10-year follow-up. Risk factors for failure included advanced age, Tönnis Grade >1, and preoperative patient-reported outcome scores. These findings provide important information on the long-term durability of PAO outcomes.

Significance/Clinical Relevance: This study is one of the first systematic reviews to examine long-term patient-reported outcomes after periacetabular osteotomy, allowing for a longitudinal scope of how patients are faring after PAO.