Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy (PAO) for hip dysplasia: a systematic review and meta-analysis

Abstract

Background: Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed.

Purpose: In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy.

Methods: A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures.

Results: From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia.

Conclusions: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants.

Registration: PROSPERO (CRD42020144748).

Keywords: Developmental dysplasia of the hip; hip dysplasia; hip joint; periacetabular osteotomy; rehabilitation.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram.

Figure 2.

Forest plot comparing Pain subscale scores in those undergoing PAO and healthy controls. Interpretation of findings: - 3.1.1 (pre-op) SMD = −4.05: large effect size (>0.8) showing worse Pain scores in PAO patients versus healthy controls preoperatively. - 3.1.2 (6 months) SMD = −2.19: large effect size (>0.8) showing worse Pain scores in PAO patients versus healthy controls at 6 months postoperatively. - 3.1.3 (12 months) SMD = −1.56: large effect size (>0.8) showing worse Pain scores in PAO patients versus healthy controls at 12 months postoperatively. - 3.1.4 (32 months) SMD = −0.83: large effect size (>0.8) showing worse Pain scores in PAO patients versus healthy controls at 32 months postoperatively. CI, confidence interval; IV, Random, random effects model; Std, standardised; SD, standard deviation; SMD, standardised mean difference; PAO, periacetabular osteotomy.

Figure 3.

Forest plot comparing Activities of Daily Living (ADL) subscale scores in those undergoing PAO and healthy controls. Interpretation of findings: • 3.3.1 (pre-op) SMD = −2.81: large effect size (>0.8) showing worse ADL scores in PAO patients versus healthy controls preoperatively. • 3.3.2 (6 months) SMD = −1.44: large effect size (>0.8) showing worse ADL scores in PAO patients versus healthy controls at 6 months postoperatively. • 3.3.3 (12 months) SMD = −1.12: large effect size (>0.8) showing worse ADL scores in PAO patients versus healthy controls at 12 months postoperatively. • 3.3.4 (32 months) SMD = −0.5: moderate effect size (0.5) showing worse ADL scores in PAO patients versus healthy controls at 32 months postoperatively. CI, confidence interval; IV, Random, random effects model; Std, standardised; SD, standard deviation; SMD, standardised mean difference; PAO, periacetabular osteotomy.

Figure 4.

Forest plot comparing Quality of Life subscale scores in those undergoing PAO and healthy controls. Interpretation of findings: • 3.6.1 (pre-op) SMD = −4.1: large effect size (>0.8) showing worse QOL scores in PAO patients versus healthy controls preoperatively. • 3.6.2 (6 months) SMD = −2.48: large effect size (>0.8) showing worse QOL scores in PAO patients versus healthy controls at 6 months postoperatively. • 3.6.3 (12 months) SMD = −1.81: large effect size (>0.8) showing worse QOL scores in PAO patients versus healthy controls at 12 months postoperatively. • 3.6.4 (32 months) SMD = −1.42: large effect size (>0.8) showing worse QOL scores in PAO patients versus healthy controls at 32 months postoperatively. CI, confidence interval; IV, Random, random effects model; Std, standardised; SD, standard deviation; SMD, standardised mean difference; QOL, quality of life; PAO, periacetabular osteotomy.