Mobility-related outcomes for periacetabular osteotomy in persons with acetabular dysplasia: setting the stage for measurement of real-world outcomes

Abstract

Periacetabular osteotomy (PAO) is a surgery for persons with symptomatic acetabular dysplasia (AD) that increases acetabular coverage of the femoral head for reducing hip pain and improving function. Patient-reported outcomes (PROs) are significantly improved following PAO, yet little is known regarding mobility-related outcomes. This narrative review provides a synthesis of evidence regarding PROs and mobility-related outcomes in persons with AD following PAO. We further identified important future research directions, chiefly the need for measurement of real-world outcomes. We searched PubMed using comprehensive predefined search terms. We included studies that (i) enrolled persons with AD undergoing PAO, (ii) included PROs and/or mobility-related outcomes and (iii) were written in English. We synthesized and summarized study characteristics and findings. Twenty-three studies were included in this review. Commonly evaluated PROs included pain (n = 14), hip function (n = 19) and quality of life (n = 9). Mobility-related outcomes included self-reported physical activity (PA; n = 11), walking speed and cadence (n = 4), device-measured PA (n = 2), and sit-to-stand, four-square-step and timed stair ascent tests (n = 1). Persons with AD had significant improvements in PROs following PAO, yet mobility-related outcomes (e.g. walking speed and device-measured PA levels) did not change over 1 year following PAO. Few studies have evaluated mobility-related outcomes following PAO, and these studies were of a low methodological quality. Future research might include experience sampling data collection approaches and body-worn devices as free-living, technology-driven methodologies to evaluate mobility and other outcomes in persons with AD undergoing PAO.

Pre- and Post-Operative Pain Intensity and Physical Activity Levels in Individuals with Acetabular Dysplasia Undergoing Periacetabular Osteotomy: A Prospective Cohort Study

“…The majority of prior studies that have examined pain improvements following PAO have evaluated pain recovery only as early as six months and later following PAO. 2,[10][11][12][13][14]18,19,45 Generally, these studies reported that pain significantly decreased/improved at six months following PAO compared to before PAO. 2,[11][12][13][14]18,19,45 However, to authors' knowledge, only one previous study has examined pain intensity earlier than six months following PAO, and reported no significant improvements in pain at four months following PAO compared with pre-PAO pain intensity.…”

“…The author team recently published a review that examined changes in pain intensity and physical activity (PA) levels in individuals with AD following PAO. 10 This review reported that pain intensity decreased at six-months compared with pre-PAO levels across several studies, 2,10–15 however, to authors’ knowledge, little evidence exists regarding pain recovery during the first six months following PAO. Our team further noted that self-reported PA levels in individuals with AD are negatively-impacted before PAO but improve one year following PAO.…”

Effects of different pelvic osteotomies on acetabular morphology in developmental dysplasia of hip in children

“…The iliac wall angle increases slowly with infant age, and there is little difference between the normal value and the outlier range, so it is necessary to compare the two sides on the X-ray film[ 41 ]. The acetabular coverage rate[ 42 ] reflects accommodation of the acetabulum to the femoral head. It is the ratio of the distance from the inner edge of the femoral head to the vertical line of the upper edge of the acetabulum to the diameter of the femoral head, and the normal value is > 75%.…”