Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Systematic Review and Meta-Analysis of Contemporary Outcomes, Survivorship, and Complications with Comparison to Isolated Periacetabular Osteotomy

Abstract

ObjectiveTo evaluate outcomes, survivorship, and complication rates among patients who underwent concomitant periacetabular osteotomy (PAO) and hip arthroscopy and compare them to patients undergoing isolated PAO. DesignSystematic review and meta-analysis SettingMedline, EBSCO host, and Google Scholar databases were searched to identify all studies describing concomitant PAO and HA through May 9, 2023 (PROSPERO study protocol registration: CRD42023426191). PatientsPatients who underwent concomitant PAO and hip arthroscopy compared to patients who underwent isolated PAO. InterventionsRandomized controlled trials and cohort studies reporting clinical outcomes after concomitant PAO and hip arthroscopy. Main Outcome MeasuresPatient-reported outcome measures (PROMs), radiographic outcomes, range of motion scores, complications, re-operations, and survivorship. ResultsThirteen studies reporting on a total of 697 patients (726 hips) were included. Significant improvements in PROMs and radiographic measures were demonstrated for most included studies. Pooled analyses demonstrated significant improvements in post-operative modified Harris Hip Score (mHHS) (mean difference (MD): -26.97, 95%CI: -30.19 to -23.75; p<0.00001) and lateral-center edge angle (LCEA; MD: -13.94, 95%CI: -16.95 to -10.93; p<0.0001) values. Patients undergoing combined procedures experienced 136 complications for 690 hips (19.71%) with 29 (21.32%) classified as major. There were 27 re-operations for 614 hips (4.40%), and post-operative survivorship estimated at minimum 85% after 3.5 years follow-up. However, for most outcome measures, there were no differences between concomitant procedures and isolated PAO. ConclusionsBased on the available literature, patients undergoing concomitant PAO and hip arthroscopy experience excellent outcomes. However, there is limited evidence to indicate that performing both procedures result in different outcomes compared to PAO alone.