Combined hip arthroscopy with periacetabular osteotomy for hip dysplasia: a systematic review

Periacetabular osteotomy (PAO) is a surgical procedure that corrects acetabular dysplasia without necessarily addressing intra-articular pathology. Hip arthroscopy is being increasingly used to address soft tissue pathologies at the time of a PAO. This review aims to determine patient-reported outcome measure scores (PROMs) of combining hip arthroscopy and PAO. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies that reported upon patient populations that had PAO's performed with arthroscopy at the time of surgery for correcting developmental hip dysplasia. We identified 428 articles; 14 full-text articles met the inclusion criteria. Between 2011 and 2022, 1083 hips from the selected articles underwent a combined PAO and arthroscopic procedure, with a mean follow-up of 3.7 years. Of the studies that reported it, 63% of the evaluated population were found to have labral tears that required either labral repair (49%), labral debridement (12%) or combined procedure. Multiple PROMs were identified in the literature, with no standardized reporting system used between articles. All articles reported statistically improved patient-reported outcomes from a combined PAO and arthroscopy procedure. There was no difference in PROMs when comparing PAO performed with or without arthroscopy. One study suggested superior outcomes for active individuals who underwent PAO and arthroscopy. Patient-reported outcome scores improve significantly after PAO with or without arthroscopy, with no differences in adverse events, and only limited evidence that active individuals benefit from labral repair.