Periacetabular osteotomy vs. total hip arthroplasty in young active patients with dysplastic hip: Systematic review and meta-analysis

Abstract

Background: In young active patients with hip dysplasia, choosing between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) is challenging.

Materials and methods: We systematically searched Medline, Embase, and Cochrane Library for studies published until October 10, 2019, comparing PAO and THA in patients with dysplastic hip. We compared postoperative complications' incidences, end-stage revisions, and clinical scores.

Results: Five studies with 431 hips (PAO: 235; THA: 196) were included. The incidence of overall and major complications was not different between groups (PAO: OR 2.14; 95% CI, 0.58-7.96; p=0.26; follow-up, 4-7.8 years; THA: OR 2.56; 95% CI, 0.60-10.98; p=0.21; follow-up, 4-7.8 years). There was also no difference in end-stage revision (OR 0.95; 95% CI, 0.33-2.79; p=0.93; follow-up, 4-7.8 years). The standard mean of Western Ontario McMasters Universities (WOMAC) pain score was higher in the THA than in the PAO group (standardized mean difference [SMD] -0.57; 95% CI, -0.93--0.21; p=0.002; follow-up, 4-5.5 years); however, the WOMAC functional score did not differ significantly between groups (SMD -0.16; 95% CI, -1.29-0.97; p=0.78; follow-up, 4-5.5 years). The standard mean UCLA activity index was higher in the PAO than in the THA group (SMD 0.28; 95% CI, 0.02-0.53; p=0.03; follow-up, 5.9-7.3 years).

Conclusions: The incidence of postoperative complications and revision surgery was not different between THA and PAO groups. However, postoperative pain was less in the THA group and the activity score was higher in the PAO group in the follow-up periods.

Level of evidence: III; meta-analysis.

Keywords: Acetabular dysplasia; Hip dysplasia; Periacetabular osteotomy; Symptomatic; Total hip arthroplasty.