Periacetabular Osteotomy for Hip Dysplasia With and Without Hip Arthroscopy: A Prospective Randomized Controlled Trial

A peri-acetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage/labral pathologies are very commonly present and there is a lack of evidence examining the benefits of the adjunct arthroscopy to these. The goal of this study is to compare the outcomes of patients undergoing PAO with and without arthroscopy. A prospective, randomized controlled multi-center trial including 203 patients with symptomatic hip dysplasia was conducted. 99 patients with hip dysplasia were randomized to receive an isolated PAO [mean age 27 years (16-44); Mean BMI of 25.1 (18.3-37.2); 83% females] and 104 patients underwent concomitant PAO with an arthroscopy [mean age 27 years (16-49); Mean BMI of 25.1 (17.5-25.1); 88% females]. Clinical outcomes were assessed pre-operatively, at 6 months, 12 months, and 24 months post-surgery, using the international Hip Outcome Tool-33 (iHOT-33), Hip Disability and Osteoarthritis Outcome (HOOS), and the (PROMIS) score. Revision and Reoperation were also recorded. There were no significant differences between the patients receiving a PAO plus arthroscopy and the patients receiving PAO alone 6-, 12-, and 24 months, post-surgery. The mean (SD) Pre-operative PROMIS score was [32.3 (SD 7.1) vs. 34.1(SD 5.8)] and 24 months post-operative was [38.7 (SD 6.3) vs. 38.5 (SD 7.0)]. Pre-operative iHot-33 score was [31.2 (SD 16.0) vs. 36.4 (SD 15.9)] and 24 months post-operative was [78.5 (SD 22.7) vs. 77.1 (SD 20.9)]. Pre-operative HOOS score was [49.9 (SD 16.9) vs. 54.2 (SD 16.9)] and 24 months post-operative was [86.8 (SD 14.1) vs. 83.3 (SD 16.0)]. 27 patients from the PAO plus arthroscopy and 28 without had reoperation for events including hardware removal, unresolved pain, and superficial wound infection. 4 patients having PAO without arthroscopy necessitated an arthroscopy later to resolve persistent symptoms and 1 patient from the PAO plus arthroscopy necessitated an additional arthroscopy. The results demonstrated an improvement in outcomes and quality of life for both groups with no significant differences in the postoperative outcomes of patients receiving PAO with and without an arthroscopy.