Ostéotomie périacétabulaire versus prothèse totale de hanche pour arthrose sur dysplasie chez les sujets jeunes et actifs : analyse systématique et méta-analyse

Background In young active patients with hip dysplasia, choosing between periacetabular osteotomy (PAO) and total hip arthroplasty (THA) is challenging. Materials and methods We systematically searched MEDLINE, Embase, and Cochrane Library for studies published until October 10, 2019, comparing PAO and THA in patients with dysplastic hip. We compared postoperative complications’ incidences, end-stage revisions, and clinical scores. Results Five studies with 431 hips (PAO: 235; THA: 196) were included. The incidence of overall and major complications was not different between groups (PAO: OR 2.14; 95 % CI, 0.58–7.96; p = 0.26; follow-up, 4–7.8 years; THA: OR 2.56; 95 % CI, 0.60–10.98; p = 0.21; follow-up, 4–7.8 years). There was also no difference in end-stage revision (OR 0.95; 95 % CI, 0.33–2.79; p = 0.93; follow-up, 4–7.8 years). The standard mean of Western Ontario McMasters Universities (WOMAC) pain score was higher in the THA than in the PAO group (standardized mean difference [SMD] −0.57; 95 % CI, −0.93 – −0.21; p = 0.002; follow-up, 4–5.5 years); however, the WOMAC functional score did not differ significantly between groups (SMD −0.16; 95 % CI, −1.29–0.97; p = 0.78; follow-up, 4–5.5 years). The standard mean UCLA activity index was higher in the PAO than in the THA group (SMD 0.28; 95 % CI, 0.02–0.53; p = 0.03; follow-up, 5.9–7.3 years). Conclusions The incidence of postoperative complications and revision surgery was not different between THA and PAO groups. However, postoperative pain was less in the THA group and the activity score was higher in the PAO group in the follow-up periods. Level of evidence III; meta-analysis.