Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy for Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review
Author(s): Kuhns BD, Becker N, Patel D, Shah PP, Domb BG.
DOI Link: 10.1016/j.arthro.2025.06.030
Background
Periacetabular osteotomy (PAO), with or without concomitant hip arthroscopy, is used to treat acetabular dysplasia. Although both isolated PAO and PAO combined with arthroscopy (PAOHS) are widely performed, variability in reporting and outcome measures limits meaningful comparison between studies.
Methods
This systematic review followed PRISMA guidelines and included studies (2014–2025) reporting outcomes for isolated PAO or PAO with hip arthroscopy. Data extracted included demographics, radiographic parameters, intra-articular findings, PROs, complications, and clinically relevant thresholds (MCID, PASS). Heterogeneity was assessed using I² statistics.
Key Findings
- 29 studies included (3,809 patients total)
- Significant postoperative improvement in all PROs for both PAO and PAOHS groups
- High prevalence of intra-articular pathology in PAOHS (68%–100%)
- Marked heterogeneity in outcomes:
- mHHS I² = 0.95
- iHOT-12 I² = 0.97
- MCID and PASS were inconsistently reported:
- PAOHS MCID: 75.9%–93.3%
- PAOHS PASS: 56.4%–91%
- No PAO-only studies reported MCID or PASS
Conclusion
Both isolated PAO and PAO with arthroscopy demonstrate significant clinical improvement; however, substantial heterogeneity in study design, outcome reporting, and thresholds limits direct comparison and conclusions regarding the added value of arthroscopy.
What Does This Mean for Providers?
Outcomes after PAO (with or without arthroscopy) appear favorable, but current literature is too inconsistent to clearly define when arthroscopy adds benefit. Standardization of PROMs and reporting thresholds is needed before meaningful comparisons can be made.