Hutchinson Katie, Baig Khurram, Smith Christian, Malviya Ajay
Department of Orthogeriatrics, Croydon University Hospital, 530 London Road, Croydon CR7 Y7E, UK.
Department of Trauma and Orthopaedics, Newcastle University, Framlington Place, Newcastle NE2 4HH, UK.
J Hip Preserv Surg. 2024 Dec 5;12(1):74-80. doi: 10.1093/jhps/hnae039. eCollection 2025 Jan.
Periacetabular osteotomy (PAO) is a surgical treatment of developmental dysplasia of the hip (DDH). This systematic review investigates the impact PAO has on sexual function and pregnancy through changes in patient-reported outcomes. A literature search of Medline, PubMed, EMBASE, and the Cochrane Library from 1996 to November 2023 was performed. Search terms included: 'periacetabular osteotomy', 'pelvic osteotomy', 'outcomes', 'sexual function', 'pregnancy', and 'childbirth'. Assessment of methodological quality was performed using the methodological index for nonrandomized studies (MINORS) criteria and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. The search returned 560 papers, with 5 meeting the inclusion criteria. Sexual function improved over both short- and longer-term follow-up periods. 48.2% of patients had improved sexual function following PAO. Female patients reported greater improvement than males, who had a higher baseline score. No complications were documented in pregnancy or delivery compared to patients who had not had a PAO. Increased rates of caesarean sections (CSs) were seen in all studies (37.4%) compared to the European average. All five papers were calculated to be of low quality according to the MINORS criteria and low certainty according to the GRADE level of evidence. Patients receiving a PAO due to symptomatic DDH had improved sexual dysfunction due to a reduction in hip pain, but almost half of these patients may not appreciate any benefit. There is an increased likelihood of CS in patients post-PAO, with no reliable evidence for its necessity. Limitations of this review included poor quality and availability of evidence, as all studies were retrospective cohort studies. Further larger powered studies are required to assess the full impact of PAO on both sexual function and pregnancy.
髋臼周围截骨术（PAO）是治疗发育性髋关节发育不良（DDH）的一种手术方法。本系统评价通过患者报告结局的变化，研究PAO对性功能和妊娠的影响。对1996年至2023年11月期间的Medline、PubMed、EMBASE和Cochrane图书馆进行了文献检索。检索词包括：“髋臼周围截骨术”、“骨盆截骨术”、“结局”、“性功能”、“妊娠”和“分娩”。使用非随机研究方法学指数（MINORS）标准和推荐分级、评估、制定与评价（GRADE）系统对方法学质量进行评估。检索共返回560篇论文，其中5篇符合纳入标准。在短期和长期随访期间，性功能均有改善。48.2%的患者在PAO后性功能得到改善。女性患者报告的改善程度高于男性，男性的基线评分更高。与未接受PAO的患者相比，妊娠或分娩中未记录到并发症。与欧洲平均水平相比，所有研究中剖宫产（CS）率均有所增加（37.4%）。根据MINORS标准，所有五篇论文的质量均为低质量，根据GRADE证据水平，确定性为低。因症状性DDH接受PAO的患者，由于髋部疼痛减轻，性功能障碍有所改善，但几乎一半的患者可能未体会到任何益处。PAO术后患者剖宫产的可能性增加，且无可靠证据表明其必要性。本综述的局限性包括证据质量差和可获得性差，因为所有研究均为回顾性队列研究。需要进一步开展更大规模的研究，以评估PAO对性功能和妊娠的全面影响。
