Pelvic osteotomies for acetabular dysplasia: Are there outcomes, survivorship and complication differences between different osteotomy techniques?

Abstract

The purpose of this study was to evaluate the safety and efficacy of Periacetabular osteotomy (PAO), rotational acetabular osteotomy (RAO), and eccentric rotational acetabular osteotomy (ERAO) for treating hip dysplasia by comparing complication rates, survivorship, and functional outcomes after treatment. A systematic review in the MEDLINE and CINAHL databases was performed, and studies reporting outcomes after pelvic osteotomy for hip dysplasia with a minimum of 1-year follow-up or reported postoperative complications was included. Patient demographics, radiographic measurements, patient reported outcomes including the modified Harris hip score (mHHS), complications using the modified Clavien-Dindo classification, and reoperations were extracted from each study. A meta-analysis of outcome scores, complications, change in acetabular coverage, and revision rates for the 3 pelvic osteotomies was performed. A total of 47 articles detailing outcomes of 6,107 patients undergoing pelvic osteotomies were included in the final analysis. When stratified by procedure, RAO had a statistically greater change in LCEA when compared to PAO (33.9° vs 18.0°; P <0.001). The average pooled mHHS improvement was 15.6 (95% CI: 8.3-22.8, I ²= 99.4%). Although ERAO had higher mean score improvements when compared to RAO and PAO, the difference was not statistically significant (P >0.05). Lastly, patients undergoing PAO had a statistically greater complication rate than those undergoing ERAO and RAO (P <0.001 for both), while revision rate was not statistically different between the 3 techniques. In summary, there are many more publications on PAO surgery with a wide range of reported complications. Complications after ERAO and RAO surgery are lower than PAO surgery in the literature, but it is unclear whether this represents an actual difference or a reporting bias. Lastly, there are no significant differences between revisions, or postoperative reported outcomes between the 3 techniques.

Fig. 1.

Flowchart demonstrating articles excluded as well as included in the final analysis. A total of 346 non-duplicate articles from the Medline and CINAHL databases were screened, with 52 included in the final analysis.

Fig. 2.

Forest plot demonstrating the heterogeneity of studies describing changes in lateral center edge angle before and after PAO, RAO and ERAO. Q-statistic: test of heterogeneity with P < 0.05 indicating significance. Df, degrees of freedom, defined as n−1; I², measure of heterogeneity where values greater than 50% indicates heterogeneous findings.

Fig. 3.

Forest plot demonstrating the heterogeneity of studies describing changes in the acetabular index or Tonnis angle before and after PAO, RAO and ERAO. Q-statistic, test of heterogeneity with P < 0.05 indicating significance; Df, degrees of freedom, defined as n−1; I², measure of heterogeneity where values greater than 50% indicates heterogeneous findings.

Fig. 4.

Forest plot demonstrating the heterogeneity of studies describing changes in the Hip Harris score or modified Hip Harris score before and after PAO, RAO and ERAO. Q-statistic, test of heterogeneity with P < 0.05 indicating significance; Df, degrees of freedom, defined as n−1; I², measure of heterogeneity where values greater than 50% indicates heterogeneous findings.

Fig. 5.

Forest plot demonstrating the heterogeneity of studies describing complication rates after PAO, RAO and ERAO. Q-statistic, test of heterogeneity with P < 0.05 indicating significance; Df, degrees of freedom, defined as n−1; I², measure of heterogeneity where values greater than 50% indicates heterogeneous findings.

Fig. 6.

Forest plot demonstrating the heterogeneity of studies describing rates of reoperation after PAO, RAO and ERAO. Q-statistic: test of heterogeneity with P < 0.05 indicating significance. Df, degrees of freedom, defined as n−1; I², measure of heterogeneity where values greater than 50% indicates heterogeneous findings.