Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
American Hip Institute, Chicago, IL, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2090-2102. doi: 10.1007/s00167-022-07108-x. Epub 2022 Aug 16.
To evaluate the literature on patients undergoing periacetabular osteotomy after failed hip arthroscopy (PAO-FHA) for (1) patient demographics and hip morphology, (2) changes in preoperative to postoperative patient-reported outcomes (PROs), and (3) PROs in comparison to primary periacetabular osteotomy (PAO) patients.
A systematic literature search of Pubmed, CINAHL/Medline, and cochrane databases was performed in accordance with PRISMA guidelines. The search phrase was "(periacetabular osteotomy or PAO or rotational osteotomy) and (hip arthroscopy or arthroscopic)". The titles, abstracts, and full texts were screened for studies on PAO-FHA. Study quality was assessed, and relevant data were collected. A meta-analysis was not performed due to study heterogeneity.
The search identified 7 studies, including 151 hips (148 patients, 93.9% female) undergoing PAO-FHA, out of an initial 593 studies, with three Level IV and four Level III studies. Mean time from hip arthroscopy to PAO ranged from 17.0 to 29.6 months. Heterogenous hip morphologies and radiologic findings prior to PAO were observed, though patients most frequently demonstrated moderate-to-severe dysplasia (mean or median lateral center edge angle < 20°) and minimal osteoarthritis (Tönnis grade 0 or 1). In all 5 studies that reported concomitant procedures with PAO, femoral and/or acetabular osteoplasty was performed via arthroscopy or arthrotomy. Following PAO-FHA, radiographic acetabular coverage and PROs improved in all 6 studies that reported postoperative outcomes. All four comparative studies of primary PAO vs. PAO-FHA included patients with mean or median LCEAs < 20°, reporting mixed outcomes for the optimal treatment approach.
PAO-FHA is reported in a heterogenous patient population that frequently includes hips with moderate-to-severe dysplasia and minimal osteoarthritis. Regardless of hip morphology or concomitant procedures, all studies that reported postoperative outcomes demonstrated improved PROs following PAO-FHA.
Level IV.
评估髋关节镜检查失败后行髋臼周围截骨术（PAO-FHA）的患者的文献，包括（1）患者人口统计学和髋关节形态学，（2）术前到术后患者报告的结果（PROs）的变化，以及（3）与原发性髋臼周围截骨术（PAO）患者的 PROs 进行比较。
根据 PRISMA 指南，对 Pubmed、CINAHL/Medline 和 cochrane 数据库进行了系统的文献检索。搜索词为“（髋臼周围截骨术或 PAO 或旋转截骨术）和（髋关节镜检查或关节镜检查）”。对 PAO-FHA 的研究进行了标题、摘要和全文筛选。评估了研究质量并收集了相关数据。由于研究的异质性，未进行荟萃分析。
该搜索确定了 7 项研究，共 151 髋（148 例患者，93.9%为女性）接受了 PAO-FHA，最初的 593 项研究中有 3 项为 IV 级研究，4 项为 III 级研究。髋关节镜检查到 PAO 的时间间隔从 17.0 到 29.6 个月不等。在 PAO 之前观察到不同的髋关节形态和放射学表现，但患者最常表现为中重度发育不良（平均或中位数外侧中心边缘角<20°）和轻度骨关节炎（Tönnis 分级 0 或 1）。在所有 5 项报告了与 PAO 同时进行的手术的研究中，通过关节镜或关节切开术进行了股骨和/或髋臼骨成形术。在所有 6 项报告术后结果的研究中，PAO-FHA 后放射学髋臼覆盖和 PROs 均得到改善。在 4 项比较原发性 PAO 与 PAO-FHA 的研究中，包括平均或中位数 LCEA<20°的患者，报告了最佳治疗方法的混合结果。
PAO-FHA 报告了一个异质的患者人群，其中经常包括中重度发育不良和轻度骨关节炎的髋关节。无论髋关节形态或同时进行的手术如何，所有报告术后结果的研究都表明，PAO-FHA 后 PROs 得到改善。
IV 级。
