EP1.63 Clinical and Radiographic Outcomes of Periacetabular Osteotomy After Prior Paediatric Pelvic Osteotomy: A Systematic Review

Abstract

Abstract Background A subset of adolescents and young adults with symptomatic residual developmental dysplasia of the hip (DDH) have previously undergone pediatric pelvic osteotomies, potentially complicating subsequent Bernese periacetabular osteotomy (PAO) due to altered pelvic anatomy and dense scarring. The impact of prior pelvic osteotomy on PAO outcomes remains unclear. Methods MEDLINE, Embase, Scopus, and Web of Science were searched from inception to March 2026 for observational studies reporting PAO in skeletally mature DDH patients with a history of pediatric pelvic osteotomy (Salter, Dega, Pemberton, Chiari, shelf, or similar). Eligible studies included ≥10 prior-osteotomy hips and reported clinical outcomes, radiographic correction, or complications, with ≥1-year mean/median follow-up. Two reviewers independently performed screening, data extraction, and Newcastle–Ottawa risk-of-bias assessment. Owing to heterogeneity in prior procedures, outcome instruments, and follow-up, findings were synthesised narratively. Results Five studies met inclusion criteria, reporting outcomes for 104 hips with prior pediatric pelvic osteotomy and approximately 350 comparator hips (primary PAO and/or non-operative dysplastic hips). Across series, PAO in previously operated hips produced substantial radiographic correction: lateral centre-edge angle typically improved by 19–24° (e.g., 5°→29° in Mayo; 1.9°→26.2° in De La Rocha; −1°→33° in Zhang), and acetabular inclination decreased by 12–18°. Adolescents with prior pelvic osteotomy in one cohort improved CEA from 6° to 25° and femoral head coverage from 58% to 75%. Clinical scores improved beyond minimal clinically important differences in all studies: mHHS increased by 10–16 points in De La Rocha, Stambough, and Zhang, and HHS by 28 points (60→88) in adolescents with prior osteotomy in Kołodziejczyk. However, in the largest comparative cohort, revision PAO after prior osteotomy achieved smaller radiographic corrections (e.g., ACEA +13° vs +25°; AI −12° vs −17°) and lower final HOOS Pain (77 vs 85) and ADL (83 vs 92) scores than matched primary PAO. Structural complications were more frequent in some prior-osteotomy groups, with posterior column fractures reported in up to 14–19% and pubic ramus nonunion in 22% in one series, and early THA conversion of 5% (2/39) versus 0% in primary PAO over similar follow-up. Shorter-term adolescent series reported low complication rates and no THA. Conclusion PAO after prior pediatric pelvic osteotomy provides clinically meaningful pain relief and radiographic correction in residual DDH, but compared with primary PAO, revision cases show smaller radiographic gains, slightly lower final functional scores, and higher rates of structural complications and early OA progression/THA in several cohorts. Prior pelvic osteotomy should be viewed as a risk modifier rather than a contraindication, and patients should be counselled regarding the technically demanding nature of surgery and a potentially lower functional ceiling.