Pain and quality of life are impaired in adults with hip dysplasia undergoing periacetabular osteotomy (PAO): A systematic review and meta-analysis

Abstract

Introduction: Little is known about the pain, sport and recreation, and quality of life (QOL) in adults with hip dysplasia undergoing periacetabular osteotomy (PAO). This systematic review aims to (i) evaluate pre to post- operative changes in pain, sport and recreation and QOL following PAO; and (ii) evaluate differences in pain, sport and recreation, and QOL in those undertaking PAO versus healthy controls. Methods: The search was performed in five databases on 05/01/2021. Included studies used a hip-specific patient-reported outcome measure and reported ≥Level IV evidence. Participants/intervention: Aged >15 years with hip dysplasia undertaking PAO surgery. Comparator: Between-group and pre- to post- intervention comparisons will be made where appropriate. Outcomes: Pain, sport and recreation, and QOL. Results: The search yielded 5,017 titles and abstracts for screening, with 62 studies included in the final analyses. Meta-analysis found low-level evidence that patients experienced clinical improvements across all subgroups one year after PAO, compared to pre-surgery, and this was maintained at the two-year timepoint. Pain improved from pre-surgery to one-year (SMC (95% CI): 1.35; 1.02 to 1.67) and two-years post-operatively (1.35; 1.16 to 1.54). Similarly, sport & recreation (one-year (1.29; 1.01 to 1.57) and two-years (1.24; 0.92 to 1.57)); and QOL (one-year (1.36; 1.22 to 1.5) two-years (1.3; 1.1 to 1.5)) all improved. Meta-analysis comparing PAO patients and healthy participants found low-level evidence that PAO patients have significantly worse outcomes across all subgroups. This occurs both pre-operatively and postoperatively at 6, 12 and 32 months. This was found for pain (SMD (95% CI): -4.05; -4.78 to -3.32), sport & recreation (-3.47; -3.79 to -3.16), and quality of life (-4.10; -4.43 to -3.77). Discussion: Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, sport and recreation and QOL compared to healthy participants. These levels improve over two years following PAO, but do not reach the same level as their asymptomatic peers. When compared to healthy controls, PAO patients experience significantly worse outcomes when compared to healthy controls, both pre-operatively and post-operatively until 32 months. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.