Periacetabular osteotomy with or without hip arthroscopy in patients with borderline hip dysplasia: A systematic review.

Abstract

The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO. A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in 4 studies (mean: 62.6-82.9). SF-12/SF-36 physical scores improved in 3 studies (37.8-47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months. In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA. Level IV, systematic review of Level III-IV studies.