Top 100 cited studies in periacetabular osteotomy for acetabular dysplasia: do lower levels of evidence guide clinical practice?

As no prior study has examined the citations profile of key articles related to periacetabular osteotomy (PAO), our analysis utilized the Web of Science database to (1) identify the most-cited clinical studies relating to PAO in the management of acetabular dysplasia and (2) assess any trends over time with respect to the quality of literature. The top 100 highest-cited studies related to PAO had a mean of 49 citations (range, 6–666 per study). With respect to the level of evidence, most studies had level IV evidence (58%); 1% level I, 16% level II, 28% level III and 2% level V. Most studies were retrospective (n = 86); there were 14 prospective studies (including one randomized study). The most common study designs were case series (n = 58) and cohort (n = 16), followed by matched-cohort (n = 13) and case–control (n = 6). The mean ± SD Newcastle-Ottawa Scale score was 6.48 ± 1.31. A total of 59 and 41 of the included articles were classified as high risk and high quality, respectively. No studies were classified as very high risk. As a whole, our analysis demonstrated that currently available PAO literature is still of low quality and of low level of evidence. While PAO has been well-documented as a durable procedure for addressing acetabular dysplasia, future research must focus on higher quality, randomized and prospective data to answer key clinical or technique-related topics.