Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: A systematic review and meta-analysis

Introduction: The Bernese periacetabular osteotomy (PAO) is a popular joint-preservation technique aimed at addressing the structural and biomechanical abnormalities associated with acetabular dyspla-sia. However, the prognostic factors and long-term survivorship of the native hip, with failure defined as conversion to total hip arthroplasty (THA), is poorly understood. Our study aims to address the following: (1) What is the estimated duration of survival of the native hip post-PAO, (2) What are some prognostic factors of functional outcome and (3) What is the complication rate and complications associated with PAO.Hypothesis: The Bernese PAO is able to result in favourable mid-to long-term outcomes conditional on a stringent patient selection criteria.Materials and methods: A systematic review was performed using the PRISMA guidelines. All studies that reported on the outcomes of isolated Bernese PAO for the treatment of acetabular dysplasia were included.Results: A total of 24 studies (3471 patients, 3655 hips) were included at a mean follow-up duration of 54.2 months (range: 1-336 months). In total, 208 hips (6.03%; 95% CI: 5.25-6.94%) converted to THA at a mean duration of 4.71 years (range: 1-240 months). Univariate analysis identified advanced age beyond a follow-up duration of 6 years (p = 0.001) and preoperative Tonnis grade 2 and above (p < 0.001) to be the most significant negative prognostic factors. Beyond a follow-up duration of 2 years, intraoperative fluoroscopy proved to be a significant positive prognostic factor (p < 0.001). Indications for PAO, obesity and gender were not found to be significant predictors of failure. Our study found the complication rate to be 23.5% (95% CI: 21.6-25.6%). The most common complications detailed are transient lateral femoral cutaneous nerve dysesthesia (8.24%; 95% CI: 7.02-9.65%), stress fracture (5.28%; 95% CI: 4.31-6.89%) and the delayed union, non-union or pseudoarthrosis of the ramus not necessitating surgical correction (3.73%, 95% CI: 2.93-4.75%).Discussion: PAO alters the natural history of the dysplastic hip with a 10-and 20-year survivorship of approximately 75.9% and 36.5% of patients respectively. The ideal patient should be below 40 years old, with a preoperative Tonnis grade of 0 or 1. Intraoperative fluoroscopy is able to guide a better precision when re-orientating the acetabulum. Level of evidence: IV; systematic review and meta-analysis.(c) 2022 Elsevier Masson SAS. All rights reserved.