EP1.89 The Efficacy of Periacetabular Osteotomy in Patients >40 Years Old: A Systematic Review

Abstract

Abstract Background Periacetabular osteotomy (PAO) is traditionally indicated for younger patients with acetabular dysplasia; however, its use in patients ≥40 years is increasing. This systematic review evaluates outcomes in this population, focusing on functional outcomes, radiographic correction, and survivorship. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Medline, EBSCO Host, and Google Scholar were queried for studies published between January 1, 2000 and January 1, 2025. Studies reporting outcomes of PAO in patients ≥40 years were included. Seven studies comprising 411 PAOs in 383 patients met inclusion criteria. Results Patients ≥40 years demonstrated consistent and clinically meaningful improvements across all reported patient-reported outcome measures, including the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, International Hip Outcome Tool–12, Hip Disability and Osteoarthritis Outcome Score–Global, Subjective Hip Value, and Merle d’Aubigne and Postel score. Comparative analyses were mixed but generally showed similar postoperative scores and magnitude of improvement relative to younger cohorts. Radiographic outcomes showed significant correction of acetabular dysplasia in older patients, including improvements in lateral center-edge angle, anterior center-edge angle, and Tönnis angle. Postoperative radiographic parameters were consistently comparable to younger cohorts, with no meaningful differences in acetabular coverage, femoral head lateralization, or acetabular roof obliquity. Survivorship free from conversion to total hip arthroplasty ranged from 58% to 91.3%, with some studies demonstrating comparable long-term survival between older and younger patients. Survivorship free from osteoarthritis progression ranged from 71.2% to 94.3%, with some evidence of increased osteoarthritis progression in older patients despite similar rates of arthroplasty conversion. Reported median survival reached up to 15.5 years. Conclusions Patients ≥40 years undergoing PAO experience significant functional and radiographic improvements comparable to younger cohorts. While survivorship may be similar in select populations, older patients may have an increased risk of osteoarthritis progression, emphasizing the importance of careful patient selection and counseling.