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Periacetabular Osteotomy in Athletes With Symptomatic Hip Dysplasia Allows for Participation in Low-, Moderate-, and High-Impact Sports, With Greater Than 70% Return to Sport for Competitive Athletes: A Systematic Review

Published:December 13, 2022DOI:https://doi.org/10.1016/j.arthro.2022.12.004

      Purpose

      To systematically review the literature and report the rate of return to sport (RTS) in athletes following periacetabular osteotomy (PAO) for symptomatic hip dysplasia.

      Methods

      A literature search of the PubMed, Embase, and Cochrane Library databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies reporting on athletes undergoing PAO surgery for symptomatic hip dysplasia. A quality assessment was performed using the Methodological Index of Non-Randomized Studies (MINORS) grading system. Data collection included study characteristics, demographics, radiographic measurements, rate and timing of RTS, baseline and most recent patient-reported outcomes (PROs), and subsequent surgeries.

      Results

      Six studies met inclusion criteria with 341 patients undergoing PAO. There were 2 level III and 4 level IV studies, with an average MINORS score of 11. Preoperative and postoperative lateral center edge angles ranged from 8° to 18° and 23° to 41.3°, respectively. One study reported solely on dancers with a 63% rate of RTS at 1 year postoperatively. Two other studies reported RTS of 80% and 82% for multiple sports, with slightly lower rates (73% and 78%) in competitive athletes. Three studies demonstrated a comparable distribution of sports participation, from the preoperative to postoperative period, in low-impact (61.4% to 72.1% and 63.7% to 85.7%), moderate-impact (10.3% to 21.0% and 4.3% to 25.4%), and high-impact (8.5% to 17.6% and 5.1% to 10.8%) sports. Three studies reported time to RTS after PAO, ranging from 8.8 to 12.8 months. Of the 3 studies noting reasons for not returning to sport, concerns related to the operative hip ranged from 36.4% to 67%. Of the studies that reported both preoperative and postoperative PROs, improvements in all values were observed, with modified Harris Hip Scores and Hip Disability Osteoarthritis Outcome Scores at most recent follow-up ranging from 81 to 95 and 72 to 93, respectively.

      Conclusions

      In athletes with symptomatic hip dysplasia undergoing PAO, postoperative participation in low-, moderate-, and high-impact sports was observed, with greater than 70% RTS for competitive athletes. These findings suggest that PAO, with appropriate indications, is an efficacious treatment option in this active patient population with severe dysplasia.

      Level of Evidence

      Level IV, systematic review of level III and IV studies.
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