Factors predicting the failure of Bernese periacetabular osteotomy: a meta-regression analysis

There is no clear evidence regarding the outcome of Bernese periacetabular osteotomy (PAO) in different patient populations. We performed systematic meta-regression analysis of 23 eligible studies. There were 1,113 patients of which 61 patients had total hip arthroplasty (THA) (endpoint) as a result of failed Bernese PAO. Univariate analysis revealed significant correlation between THA and presence of grade 2/grade 3 arthritis, Merle de'Aubigne score (MDS), Harris hip score and Tonnis angle, change in lateral centre edge (LCE) angle, late proximal femoral osteotomies, and heterotrophic ossification (HO) resection. Multivariate analysis showed that the odds of having THA increases with grade 2/grade 3 osteoarthritis (3.36 times), joint penetration (3.12 times), low preoperative MDS (1.59 times), late PFO (1.59 times), presence of preoperative subluxation (1.22 times), previous hip operations (1.14 times), and concomitant PFO (1.09 times). In the absence of randomised controlled studies, the findings of this analysis can help the surgeon to make treatment decisions.