Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy for Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review.

Abstract

To report preoperative and intraoperative variables as well as patient-reported outcome measures (PROMs) of patients receiving either isolated periacetabular osteotomy (PAO) or combined hip arthroscopy with PAO (PAOHS) for the surgical management of acetabular dysplasia. A review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted to identify studies published between January 2014 and March 2025 that reported PROMs for combined arthroscopic hip surgery with PAO (PAOHS) or isolated PAO. Patient demographics, radiographic variables, surgical data, as well as postoperative PROMs and complications were recorded. Forest plots were used to identify heterogeneity using the I² statistic. In total, 29 studies (13 PAOHS; 18 PAO) with 3,809 patients were included in the review. Rates of intra-articular pathology for the PAOHS studies ranged from 68% to 100%. Level of evidence ranged from I-IV. The most common PROMs used by both the PAO and PAOHS studies were the modified Harris Hip Score (53% vs 70%) and the International Hip Outcome Tool-12 (26% vs 40%), whereas other outcome scores were used more infrequently between the 2 groups. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the modified Harris Hip Score (I² = 0.95) and International Hip Outcome Tool-12 (I² = 0.97). Five studies in the PAOHS group reported clinically relevant outcomes including the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS), with MCID rates ranging 75.9-93.3% and PASS rates ranging from 56.4% to 91%. No studies in the isolated PAO group reported on the MCID or PASS. Although there was sustained PROM improvement for both the PAO and PAOHS, there was significant heterogeneity and little comparability between the 2 groups of studies, limiting potential conclusions regarding the efficacy of intra-articular intervention despite high levels of intra-articular pathology identified in the PAOHS studies. Level IV, systematic review of Level I to IV studies.