EP1.6 Periacetabular Osteotomy in Perthes and Perthes-Like Deformities: A Systematic Review of Isolated and Combined PAO Procedure Outcomes

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ID: 331194
2026
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Abstract
Abstract Background Periacetabular Osteotomy (PAO) has an established role in hip dysplasia, but its application in residual Legg-Calvé-Perthes disease has never been systematically reviewed. In the mechanically heterogenous residual Perthes hip, symptoms arise from impingement, incongruence and instability (the three ‘I’s’); of these pathobiomechanical factors, PAO primarily addresses instability. Aim This systematic review aims to synthesise clinical and radiographic outcomes of PAO, performed alone or in combination, in patients with Perthes and Perthes-like deformities, in order to evaluate procedural utility and assess survivorship measures, such as the rate and timing of conversion to total hip replacement (THR). Methods A PRISMA-compliant systematic search of MEDLINE, Embase and the Cochrane Library was conducted by two independent reviewers. Nine retrospective studies with isolatable clinical or radiographic outcomes of PAO in Perthes or Perthes-like deformities met inclusion criteria. Continuous outcomes were synthesised using a sample-size (n-hips) weighted approach due to inconsistent variance reporting; pooled dispersion was summarised using weighted SD with approximate 95% CIs. Binary outcomes were summarised as proportions with Wilson 95% confidence intervals. Complications were classified using the Clavien–Dindo system. Results Radiographic synthesis demonstrated structural correction. Across 7 studies (95 hips), the pooled weighted improvement in LCEA was +25.1°. Across 5 studies (62 hips), extrusion index decreased by −26.19%. Sourcil angle decreased by −15.82° across 2 studies (39 hips), while femoral head sphericity increased by +20.38% across 3 studies (29 hips). Functional outcomes saw pooled weighted gains of +27.23 points in mHHS (4 studies, 58 hips) and +20.79 points in HHS (4 studies, 83 hips). Eight of nine studies reported complications. Major (Clavien–Dindo III–V) complications occurred in 4.96% (7/141; 95% CI 2.43–9.89) and minor (I–II) complications in 2.84% (4/141; 95% CI 1.11–7.07). Conversion to THR was 4.96% (7/141) in studies with compatible follow-up, and 4.04% (8/198) in sensitivity analysis. Conclusion In Perthes patients with acetabular instability, PAO produces functional and radiographic improvements with complication rates comparable to, or lower than, hip dysplasia populations. When integrated within a broader reconstructive strategy, PAO yields clinically significant patient improvement and is a useful hip preservation strategy.
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Authors Jessica Armitage, Ahmad Joumah, Manal Khanzada, Mark Sohatee
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.190
URL
https://doi.org/10.1093/jhps/hnag043.190
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