Combined Hip Arthroscopy and PAO Performed Under the Same Anesthesia Event Results in Significant Improvement in Outcomes at Short-and-Medium-Term Follow-Up with Low Rates of Complications and Conversion to Total Hip Arthroplasty.

Abstract

Purpose: To summarize and evaluate the surgical technique, patient reported outcomes (PROs) and complications of combined periacetabular osteotomy (PAO) and hip arthroscopy for the treatment of hip dysplasia and intra- and extra-articular hip pathology, respectively.

Methods: Clinical studies evaluating outcomes of simultaneous combined hip arthroscopy and PAO procedures performed under the same anesthesia event were identified in PubMed, Embase, The Cochrane Library per the PRISMA guidelines up to October 10, 2024. PROs, complications, intraoperative procedures, radiographic parameters, and demographic factors were assessed. Study quality and bias were assessed using the Modified Coleman Score and Methodological index for non-randomized studies (MINORS). Studies assessing hip arthroscopy and PAO not performed under the same anesthesia event were excluded.

Results: Twelve studies with 730 hips (612 female and 118 male) were included with average follow-up time ranging from 1.7 to 12.8 years. Eleven studies reported PROs and all studies that compared postoperative and baseline outcomes reported a statistically significant improvement in modified Harris Hip Score (mHHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), Hip Outcome Score - Sport (HOS-Sport), and Visual Analog Scale - Pain (VAS-Pain) postoperatively compared to baseline. mHHS, VAS-Pain, and NAHS ranged from 55-72 preoperatively to 82-90 postoperatively, 5.1-6 preoperatively to 1.9-3 postoperatively, and 57-61 preoperatively to 80-90 postoperatively, respectively. MCID was reported in 4 studies and PASS in 2 studies. Thirty-three hips (4.5%) experienced complications, and 8 hips (1%) converted to total hip arthroplasty. The median MCMS and MINSORS were 59 (Range: 43 - 65), and the median MINORS score was 12 (Range: 11-14) for non-comparative studies and 20.5 (Range: 19-22) for comparative studies.

Conclusion: Combined hip arthroscopy and PAO results in statistically significant improvement in PROs, low complication rates, and low conversion to arthroplasty at short to medium-term follow-up.

Level of evidence: IV (Range: III to IV); Systematic Review.