Patient-Reported Outcomes After Periacetabular Osteotomy Versus Hip Arthroscopy for Borderline Acetabular Dysplasia Are Both Favorable: A Systematic Review
Abstract
Purpose: To compare patient populations and outcomes in studies treating borderline hip dysplasia (BHD) with either hip arthroscopy or periacetabular osteotomy (PAO).
Methods: We conducted a literature review according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies published after 2014 that reported patient-reported outcome measures (PROMs) after hip arthroscopy or PAO for BHD. Preoperative demographic characteristics, radiographic variables, operative findings, procedures, postoperative outcomes, and complications were recorded. Forest plots of disaggregated data were constructed to identify study heterogeneity using the I2 statistic.
Results: In total, 26 studies (8 PAO and 18 arthroscopy) were included. Acetabular morphology was comparable between the PAO and arthroscopy studies, whereas the arthroscopy studies reported higher alpha angles (range, 48.3°-75.3°) than the PAO studies (range, 47.6°-55°). No PAO studies reported an average alpha angle greater than 60°; in contrast, this was reported in 71% of arthroscopy studies. The most common PROMs were the modified Harris Hip Score, with average improvement ranging from 20 to 29 for PAO and from 17.9 to 34.4 for arthroscopy, and the International Hip Outcome Tool 12, with mean postoperative scores ranging from 73.3 to 74.3 for PAO and from 67.5 to 85.4 for arthroscopy. Postoperative PROM improvement was significant for all studies, with significant heterogeneity for the modified Harris Hip Score (I2 = 0.90) and International Hip Outcome Tool 12 score (I2 = 0.98).
Conclusions: There was significant postoperative improvement after both PAO and hip arthroscopy for the surgical management of BHD, with high levels of heterogeneity limiting comparability between study groups. Hip arthroscopy studies recorded higher alpha angles, suggesting that cam deformities in the setting of BHD can be managed arthroscopically.