Is Periacetabular Osteotomy With Hip Arthroscopy Superior to Periacetabular Osteotomy Alone? A Systematic Review and Meta-Analysis.

Introduction: There remains ongoing controversy regarding the optimal treatment strategy of hip dysplasia, with some advocating for the addition of hip arthroscopy to periacetabular osteotomy (PAO) to address concomitant labral tears. The purpose of this systematic review was to compare the clinical outcomes, complications, and joint preservation of PAO and PAO with hip arthroscopy.

Methods: A literature search was done, and studies were included if they reported outcomes of PAO with concomitant hip arthroscopy, PAO with staged hip arthroscopy, or compared outcomes of PAO alone versus PAO with hip arthroscopy. A meta-analysis was conducted with respect to studies who compared preoperative to postoperative change in modified Harris Hip Score between PAO and PAO with hip arthroscopy.

Results: Twenty studies were included in this review. Most patients demonstrated preoperative labral pathology. Pooled analysis of the postoperative change in modified Harris Hip Score showed no difference between PAO with concomitant hip arthroscopy and PAO alone (P = 0.238). Three of six studies comparing both surgical techniques demonstrated a notable postoperative improvement for select outcome scores for the PAO plus hip arthroscopy group but not for the PAO alone group. Of note, no studies demonstrated a notable improvement in the PAO alone group compared with PAO plus hip arthroscopy. The rates of complications and conversion to total hip arthroplasty for both procedures were notably similar.

Conclusion: Favorable and comparable clinical outcomes were observed for both PAO alone and PAO with hip arthroscopy. Although PAO with hip arthroscopy demonstrated statistically superior clinical outcomes for some measures, it was never inferior to PAO alone. Randomized controlled studies with extended follow-up are needed to better understand the potential difference in long-term outcomes and rates of conversion to total hip arthroplasty between these procedures.