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Comparable outcomes in male and female patients undergoing periacetabular osteotomy
Quentin Karisch1, Chiara Heller1, Justus Stamp1
1Department of Orthopedics Hannover Medical School Hannover Germany.
Purpose:
Periacetabular osteotomy (PAO) is an established treatment for DDH with generally favourable outcomes. Although developmental hip dysplasia (DDH) is more prevalant in females, it remains unclear whether male patients achieve comparable patient reported outcome, with some studies suggesting inferior outcome in men. The aim of this study was to evaluate short-term outcomes of PAO in male versus female hips.
Methods:
A prospective PAO registry was utilized and predefined inclusion criteria applied. A total of 282 hips (44 male, 238 female) that had undergone PAO surgery between 2022 and 2024 by a single surgeon were included. Radiographic measures and patient-reported outcome measures (PROMs), including the University of California, Los Angeles activity scale (UCLA), Hip Disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), international hip outcome tool-12 (iHOT-12), Harris hip score (HHS), modified Harris Hip Score (mHHS) and Postel-Merle d'Aubigné (PMA) score, were assessed preoperatively and at final follow-up and compared between sexes.
Results:
Preoperatively, male patients had higher BMI (27.07 vs. 25.01, p = 0.019), greater anterior (Anterior wall coverage [AC] 48.09 vs. 41.28, p = 0.008) but lower posterior acetabular coverage (Posterior wall coverage [PC] 78.21 vs. 85.77, p = 0.010) and more concomitant procedures (54.5% vs. 18.5%, p < 0.001). The UCLA was the only PROM showing a significant sex-related difference in preoperative values. Both sexes improved significantly in most PROMs, with no significant differences in the magnitude of improvement. Likewise, achievement rates of PASS and MCID for mHHS and iHOT-12 were comparable between sexes. Given the small number of male patients, results should be interpreted with caution due to potential limited statistical power.
Conclusion:
The findings of this study demonstrate that there are no significant sex-related differences in the clinical burden of DDH or in short-term outcomes after PAO in patients with this diagnosis. Both males and females showed substantial improvement after PAO, indicating that the procedure provides similarly favourable outcomes for both sexes. Based on these results, gender should not influence decision-making in PAO surgery.
Level Of Evidence:
Level III.
